What are the requirements of a physician to collaborate with a Texas NP?

To collaborate with a Texas NP, a physician must execute a written Prescriptive Authority Agreement (PAA) with specific required contents, review and sign it at least annually, and make it available to the Boards within three business days upon request¹. The physician must register the delegation with the Texas Medical Board within 30 days of signing the PAA (including APRN identity, execution date, practice addresses, and whether the practice serves a medically underserved population) and shall notify the Texas Medical Board in writing within 30 days if the agreement is terminated²³.

Supervision requirements do not mandate the physician’s physical presence at all times⁴. Generally, a physician may supervise a maximum of seven APRNs/PAs (or the full-time equivalent of seven), but no cap applies in facility-based hospital practices and practices serving a medically underserved population; the physician and NP must meet at least monthly, and each meeting should be documented¹⁴.

Operationally, the delegating physician must devise and enforce a system to account for and monitor issuance of prescriptions under the physician’s supervision⁵, and must notify the APRN if the physician becomes the subject of a Texas Medical Board investigation¹. If delegating nonsurgical medical cosmetic procedures, the physician must ensure detailed written protocols or standing orders, appropriate training, quality assurance mechanisms, patient consent, and proper documentation are in place⁶.