Follow the steps to complete the TX TAFP Background Prescriptive Authority Agreement online.

1. Click the ‘Get Form’ button to access the document and open it for editing.
2. Enter the name, license number, and address of the delegating physician at the specified section of the form.
3. Provide the name, license number, and address of the advanced practice registered nurse or physician assistant to whom prescriptive authority is delegated.
4. Indicate the nature of the practice and the specific practice location(s) where the agreement will apply.
5. Specify the categories of drugs or devices that may be prescribed. You can select all dangerous drugs, all schedule III-V controlled substances, or list permissible drugs or devices with any limitations.
6. Describe the general plan for addressing consultation and referral of patients. Include any additional protocols as necessary.
7. Outline the plan for managing patient emergencies. This should detail actions that will be taken in various emergency scenarios.
8. Explain the general process for communication and sharing information regarding patient care between the physician and the APRN or PA.
9. Develop a prescriptive-authority quality assurance and improvement plan, specifying how its implementation will be documented.
10. Select the frequency of the quality assurance meetings, choosing between monthly, quarterly, or other, as allowed by law.
11. If applicable, provide the name and license number of alternate supervising physician(s), ensuring to recommend signatures.
12. Ensure that the APRN or PA acknowledges their authority to prescribe under Chapter 157 of the Texas Occupations Code.
13. Confirm that the APRN or PA is in good standing in Texas and disclose any prior disciplinary actions.
14. The physician must acknowledge any prior disciplinary actions and sign the agreement.
15. Complete the date of the agreement and set a date for the periodic review, ensuring compliance with review requirements.
16. After reviewing all entries for accuracy, save your changes, and download, print, or share the completed form as necessary.

Complete your TX TAFP Background Prescriptive Authority Agreement online today to ensure compliance and effective delegation of prescriptive authority.