1. (a) The following words and terms, (concerning General Definitions) when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise.

   1. (1) Acceptable approved medical school--A medical school or college located in the United States or Canada that has been accredited by the Liaison Committee on Medical Education or the American Osteopathic Association Bureau of Professional Education.

   2. (2) Acceptable unapproved medical school--A school or college located outside the United States or Canada that:

      1. (A) is substantially equivalent to a Texas medical school; and
      2. (B) has not been disapproved by another state physician licensing agency unless the applicant can provide evidence that the disapproval was unfounded.
   3. (3) Affiliated hospital--Affiliation status of a hospital with a medical school as defined by the Liaison Committee on Medical Education and documented by the medical school in its application for accreditation.
   4. (4) Applicant--One who files an application as defined in this section.

   5. (5) Application--An application is all documents and information necessary to complete an applicant's request for licensure including the following:

      1. (A) forms furnished by the board, completed by the applicant:

         1. (i) all forms and addenda requiring a written response must be typed or printed in ink;
         2. (ii) photographs must meet United States Government passport standards;
      2. (B) all documents required under section 163.5 of this title (relating to Licensure Documentation); and
      3. (C) the required fee, payable by check through a United States bank.
   6. (6) Board--Texas State Board of Medical Examiners
   7. (7) Continuous--12 month periods of uninterrupted postgraduate training with no absences greater than 21 days, unless such absences have been approved by the training program.
   8. (8) Eligible for licensure in country of graduation--An applicant must be eligible for licensure in the country in which the medical school is located except for any citizenship requirements.

   9. (9) Examinations accepted by the board for licensure.

      1. (A) United States Medical Licensing Examination (USMLE), with a score of 75 or better, or a passing grade if applicable, on each step, with all steps passed within seven years;
      2. (B) Federation Licensing Examination (FLEX), on or after July 1, 1985, passage of both components within seven years with a score of 75 or better on each component;
      3. (C) Federation Licensing Examination (FLEX), before July 1, 1985, with a FLEX weighted average of 75 or better in one sitting;
      4. (D) National Board of Medical Examiners Examination (NBME) or its successor with all steps passed within seven years;
      5. (E) National Board of Osteopathic Medical Examiners Examination (NBOME) or its successor with all steps passed within seven years;
      6. (F) Medical Council of Canada Examination (LMCC) or its successor, with all steps passed within seven years;
      7. (G) State board licensing examination, passed before January 1, 1977, (with the exception of Virgin Islands, Guam, Tennessee Osteopathic Board or Puerto Rico then the exams must be passed before July 1, 1963); or

      8. (H) One of the following examination combinations with a score of 75 or better on each part, level, component, or step, all parts, levels, components, or steps must be passed within seven years:

         1. (i) FLEX I plus USMLE 3;
         2. (ii) USMLE 1 and USMLE 2 (including passage of the clinical skills component if applicable), plus FLEX II;
         3. (iii) NBME I or USMLE 1, plus NBME II or USMLE 2 (including passage of the clinical skills component if applicable), plus NBME III or USMLE 3;
         4. (iv) NBME I or USMLE 1, plus NBME II or USMLE 2 (including passage of the clinical skills component if applicable), plus FLEX II;
         5. (v) NBOME I, plus NBOME II, plus FLEX II;
         6. (vi) the NBOME Part I or COMLEX Level I and NBOME Part II or COMLEX Level II and NBOME Part III or COMLEX Level III.
      9. (I) An applicant must pass each part of an examination within three attempts, except that an applicant who has passed all but one part of an examination within three attempts may take the remaining part of the examination one additional time.

      10. (J) Notwithstanding subparagraph (I) of this paragraph, an applicant is considered to have satisfied the requirements of this section if the applicant:

          1. (i) passed all but one part of an examination approved by the board within three attempts and passed the remaining part of the examination within five attempts;

          2. (ii) is specialty board certified by a specialty board that:

             1. (I) is a member of the American Board of Medical Specialties; or
             2. (II) is a member of the Bureau of Osteopathic Specialists; and
          3. (iii) completed in this state an additional two years of postgraduate medical training approved by the board.

      11. (K) An applicant who has not passed an examination for licensure in a ten-year period prior to the filing date of the application must:

          1. (i) pass a monitored specialty certification examination or formal evaluation, a monitored recertification examination or formal evaluation, or a monitored examination of continued demonstration of qualifications by a board that is a member of the American Board of Medical Specialties or the Bureau of Osteopathic Specialists within the preceding ten years;
          2. (ii) obtain through extraordinary circumstances, unique training equal to the training required for specialty certification as determined by a committee of the board and approved by the board, including but not limited to participation for at least six months in a training program approved by the board within twelve months prior to the application for licensure; or
          3. (iii) pass the Special Purpose Examination (SPEX) within the preceding ten years.
   10. (10) Good professional character--An applicant for licensure must not be in violation of or committed any act described in the Medical Practice Act, Tex. Occ. Code Ann. §§164.051-.053.

   11. (11) One-year training program--a program that is one continuous year of postgraduate training approved by the board that is:

       1. (A) accepted for certification by a specialty board that is a member of the American Board of Medical Specialties or the Bureau of Osteopathic Specialists; or

       2. (B) accredited by one of the following:

          1. (i) the Accreditation Council for Graduate Medical Education, or its predecessor;
          2. (ii) the American Osteopathic Association;
          3. (iii) the Committee on Accreditation of Preregistration Physician Training Programs, Federation of Provincial Medical Licensing Authorities of Canada;
          4. (iv) the Royal College of Physicians and Surgeons of Canada; or
          5. (v) the College of Family Physicians of Canada; or
       3. (C) a postresidency program, usually called a fellowship, performed in the U.S. or Canada and approved by the board for additional training in a medical specialty or subspecialty.
   12. (12) Sixty (60) semester hours of college courses--60 semester hours of college courses other than in medical school that are acceptable to The University of Texas at Austin for credit on a bachelor of arts degree or a bachelor of science degree; the entire primary, secondary, and premedical education required in the country of medical school graduation, if the medical school is located outside the United States or Canada; or substantially equivalent courses as determined by the board.

   13. (13) Substantially equivalent to a Texas medical school--A medical school or college that is an institution of higher learning designed to select and educate medical students; provide students with the opportunity to acquire a sound basic medical education through training in basic sciences and clinical sciences. The school should provide information about the school's program of advancement of knowledge through research; the school's development of programs of graduate medical education to produce practitioners, teachers, and researchers; and, the school's program to provide opportunity for postgraduate and continuing medical education, for the board's consideration. In addition to be determined substantially equivalent to a Texas medical school, the medical school's characteristics shall include, but not be limited to, the following:

       1. (A) The facilities for basic sciences and clinical training (i.e., laboratories, hospitals, library, etc.) shall be adequate to ensure opportunity for proper education.
       2. (B) The admissions standards shall ensure that the medical school has a pool of applicants sufficiently large and possessing United States national level qualifications to fill its entering class. Medical schools must select students who possess the intelligence, integrity, and personal and emotional characteristics necessary for them to become effective physicians.
       3. (C) The basic sciences curriculum shall include the contemporary content of those expanded disciplines that have been traditionally titled gross anatomy, biochemistry, biology, physiology, microbiology, immunology, pathology, pharmacology, and neuroscience, as defined by the Texas Higher Education Coordinating Board , the Liaison Council on Medical Education, and/or the American Osteopathic Association Bureau of Professional Education .
       4. (D) The fundamental clinical subjects, which shall be offered in the form of required patient-related clerkships, are internal medicine, obstetrics and gynecology, pediatrics, psychiatry, family practice, and surgery, as defined by the Texas Higher Education Coordinating Board , the Liaison Council on Medical Education, and/or American Osteopathic Association Bureau of Professional Education .
       5. (E) The curriculum shall be of at least 130 weeks in duration.
       6. (F) There must be integrated institutional responsibility for the overall design, management and evaluation of a coherent and coordinated curriculum.
       7. (G) For schools that have geographically separated programs, the principal academic officer of each geographically remote site must coordinate the curriculum with an academic officer of the medical school responsible for organizing the educational program.
   14. (14) Texas Medical Jurisprudence Examination (JP exam): the ethics examination developed by the board for licensure that must be passed by an applicant for licensure within three attempts with a score 75 or better.

   15. (15) Three-year training program--three continuous years of postgraduate training in the United States or Canada, progressive in nature and acceptable for specialty board certification in one specialty area that is:

       1. (A) accredited by one of the following:

          1. (i) the Accreditation Council for Graduate Medical Education;
          2. (ii) the American Osteopathic Association;
          3. (iii) the Committee on Accreditation of Preregistration Physician Training Programs, Federation of Provincial Medical Licensing Authorities of Canada;
          4. (iv) the Royal College of Physicians and Surgeons of Canada;
          5. (v) the College of Family Physicians of Canada; or
          6. (vi) all programs approved by the board after August 25, 1984; or
       2. (B) a board-approved program for which a Faculty Temporary Permit was issued; or
       3. (C) a postresidency program, usually called a fellowship, for additional training in a medical specialty or subspecialty, approved by the Texas State Board of Medical Examiners.

2. (b) The following words and terms, (concerning Telemedicine/Practice Across State Line/Practice of Medicine Definitions) when used in this chapter shall have the following meanings unless the context clearly indicates otherwise.

   1. (1) Act that is part of patient care service--Any diagnosis, assessment, or treatment including the taking of diagnostic imaging studies as well as the preparation of pathological material for examination.
   2. (2) Episodic consultation--Consultation on an irregular or infrequent basis involving no more than 24 patients of a physician's diagnostic or therapeutic practice per calendar year. Multiple consultations may be performed for one or more patients up to 24 patients per calendar year.
   3. (3) Informal consultation--Consultation performed outside the context of a contractual relationship and on an irregular or infrequent basis without the expectation of or exchange of direct or indirect compensation.
   4. (4) Patient care service initiated in this state--Any act constituting the practice of medicine as defined in this chapter in which the patient is physically located in Texas at the time of diagnosis, treatment, or testing.
   5. (5) Person--An individual unless otherwise expressly made applicable to a partnership, association, or corporation.

   6. (6) Practice of medicine--A person shall be considered to be practicing medicine under any of the following circumstances listed in subparagraphs (A) - (D) of this paragraph. This definition does not negate the responsibility of applicants to demonstrate engagement in the active practice of medicine as set forth in section 163.11 of this title (relating to Active Practice of Medicine).

      1. (A) the person publicly professes to be a physician or surgeon and diagnoses, treats, or offers to treat any mental or physical disease or disorder, or any physical deformity or injury by any system or method or to effect cures thereof;
      2. (B) the person diagnoses, treats or offers to treat any mental or physical disease or disorder, or any physical deformity or injury by any system or method and to effect cures thereof and charges therefor, directly or indirectly, money or other compensation;
      3. (C) the person exercises medical judgment, renders an opinion, or gives advice concerning the diagnosis or treatment of a patient, or makes any determination regarding the appropriate or necessary medical response to a particular patient's medical condition that affects the medical care of the patient; or
      4. (D) the person is physically located in another jurisdiction, other than the state of Texas, and through any medium performs an act that is part of patient care service initiated in this state that would affect the diagnosis or treatment of the patient.
   7. (7) State--Any state, territory, or insular possession of the United States and the District of Columbia.

Source Note:The provisions of this §163.1 adopted to be effective November 10, 1999, 24 TexReg 9835; amended to be effective March 5, 2000, 25 TexReg 1623; amended to be effective October 17, 2001, 26 TexReg 8069; amended to be effective March 7, 2002, 27 TexReg 1487; amended to be effective September 19, 2002, 27 TexReg 8769; amended to be effective January 9, 2003, 28 TexReg 67; amended to be effective April 27, 2003, 28 TexReg 3324; amended to be effective November 30, 2003, 28 TexReg 10480; amended to be effective May 2, 2004, 29 TexReg 3961; amended to be effective November 7, 2004, 29 TexReg 10104; amended to be effective March 6, 2005, 30 TexReg 1075.