A summary of Texas' collaboration, agreement, filing, supervision, prescribing, and specialty rules for NPs and the physicians who collaborate with them.
Collaborating Physician Required? Yes
Physician Involvement: High
Agreement Name: Prescriptive authority agreement
On-Site Requirements: None.
Chart Review: Required, but no fixed count. The number of charts is set by the NP and physician in the agreement’s quality-assurance plan.
Controlled Substances: Allowed. Schedules III–V (90-day limit; refills after physician consultation). Schedule II only in limited hospital or hospice settings.
Reduced Supervision / Transition Requirements: None. Texas has no transition-to-independence pathway for NPs.
Texas NP Collaboration Requirements Summary
A nurse practitioner in Texas must have a delegating physician to prescribe medications. Texas is a collaborative-practice state built around a written prescriptive authority agreement: a physician delegates prescribing authority to the NP, and the two stay connected through at least monthly meetings and ongoing chart review. The physician does not have to be on site, and there is no pathway to independent practice.
Source: Tex. Occ. Code § 157.0512
Type of Collaborative Relationship
A nurse practitioner in Texas practices under a delegating physician who stays actively involved but does not need to be on site. The physician delegates prescribing authority through a written prescriptive authority agreement, and Texas has no pathway to independent practice or reduced supervision. Texas law does not automatically make the physician legally responsible for the NP’s care; the NP retains professional accountability for the care they provide.
Source: Tex. Occ. Code § 157.0512
What is an NP’s scope of practice in Texas?
Texas NPs provide advanced practice nursing care and may prescribe drugs and devices, but only under prescribing authority delegated by a physician. A prescriptive authority agreement defines the categories of drugs and devices the NP may prescribe and how the NP and physician work together.
Do NPs need a collaborating physician in Texas?
Yes. To prescribe, a Texas NP must have a prescriptive authority agreement with a delegating physician who is actively involved through monthly meetings and chart review.
Can NPs practice independently in Texas?
No. Texas has no independent-practice pathway for NPs; a delegating physician is required, and there is no transition to reduced supervision or independence.
How many NPs can a physician supervise in Texas?
Up to seven. A physician may hold prescriptive authority agreements with up to seven NPs and physician assistants combined (or the full-time equivalent of seven). This cap does not apply in practices serving a medically underserved population or in a hospital facility-based practice.
Who can be a collaborating physician in Texas?
Any delegating physician — Texas sets no specialty-matching requirement. The physician does not have to practice in the same specialty as the NP.
Are there proximity or in-person requirements in Texas?
No. Texas sets no on-site, proximity, or travel requirement, and there is no separate physician-availability standard.
Collaboration Agreement Requirements
The written agreement in Texas is called a prescriptive authority agreement, and it must be signed and dated by the NP and the physician. It must cover the parties’ names, addresses, and license numbers; the nature and locations of the practice; the categories of drugs or devices the NP may or may not prescribe; plans for consultation, referral, and patient emergencies; how the NP and physician communicate; any alternate physician, if one is used; and a quality-assurance plan describing chart review and at least monthly meetings. The agreement is reviewed, dated, and re-signed at least annually and kept at the NP’s practice site.
Source: Tex. Occ. Code § 157.0512(e)
What must be included in an NP collaborative agreement in Texas?
The agreement must be in writing and signed and dated by both parties. It must state each party’s name, address, and license numbers; the nature and locations of the practice; the categories of drugs or devices that may or may not be prescribed; plans for consultation, referral, and patient emergencies; the communication process between the NP and physician; and a quality-assurance plan describing chart review and periodicmeetings.
What is the collaborative agreement called in Texas?
It is called a prescriptive authority agreement.
Who has to sign the collaborative agreement in Texas?
The NP and the delegating physician. Both parties to the agreement must sign and date it.
How often must the agreement be reviewed or renewed in Texas?
At least annually. The agreement and any amendments must be reviewed, dated, and re-signed by the parties at least once a year.
Is a backup physician required in Texas?
No. A backup is optional. If alternate physician coverage is used, one or more alternate physicians may be designated in the agreement, but this is not required.
Board Filing Requirements
The prescriptive authority agreement itself does not have to be filed in Texas, but the delegating physician must register the delegation with the Texas Medical Board. The physician registers the NP’s name and license number within 30 calendar days of the delegation.
Source: Tex. Occ. Code § 157.051(b-2); 22 TAC § 169.5
Do you have to file the collaborative agreement with the board in Texas?
No, the agreement itself is not filed. Instead, the delegating physician must register the delegation with the board within 30 calendar days.
Can an NP start practicing as soon as they file in Texas?
Yes. The physician’s delegation is valid upon registration; the physician must complete that registration within 30 days of the delegation.
What are the termination and notice requirements in Texas?
The delegating physician must notify the board in writing within 30 days of termination. Any party to the agreement may submit the notice of termination.
Collaboration Compliance
Once the agreement is active in Texas, the NP and physician must meet at least monthly and review charts on an ongoing basis. The monthly meetings must be documented, and the agreement must be kept for two years after it ends. Texas does not require chart co-signing or any heightened supervision for controlled substances beyond the prescribing rules themselves.
Source: Tex. Occ. Code § 157.0512(f)
How many charts must a collaborating physician review in Texas?
There is no fixed count. Chart review is required, but the number of charts is set by the NP and physician in the agreement’s quality-assurance plan.
How often must an NP and collaborating physician meet in Texas?
At least once a month. The monthly meetings must be documented; the format is determined by the NP and physician.
How long must collaboration records be kept in Texas?
Two years. Each party must keep a copy of the agreement until the second anniversary of the date it is terminated, and monthly meetings must be documented.
Prescribing Rules
Texas NPs may prescribe drugs and devices — including many controlled substances — under authority delegated by a physician in the prescriptive authority agreement. Controlled-substance prescribing is limited: Schedules III–V are allowed with restrictions, and Schedule II is available only in narrow hospital or hospice settings. Federal DEA registration is required to prescribe any controlled substance.
Source: Tex. Occ. Code § 157.0511
Can an NP prescribe controlled substances in Texas?
Yes, but with limits. An NP may prescribe controlled substances in Schedules III–V under delegated authority. Each prescription, including refills, is limited to a 90-day supply, and refills must be authorized after consultation with the physician.
Can an NP prescribe Schedule II drugs in Texas?
Generally no. Schedule II prescribing is allowed only in limited settings: a hospital facility-based practice (for a patient admitted for 24 hours or more, or seen in the emergency department) or as part of hospice care for a patient under specific circumstances.
What schedule drugs can an NP prescribe in Texas?
Schedules III, IV, and V generally, plus Schedule II only in very limited hospital and hospice settings. Prescriptions for Schedules III–V are capped at a 90-day supply.
Does an NP need a DEA license in Texas?
Yes, to prescribe controlled substances. Texas defers to federal DEA regulations and does not describe a separate state controlled-substance registration; an NP transferring a DEA registration from another state should confirm requirements with the DEA directly.
Can an NP prescribe independently in Texas?
No. Prescribing authority is delegated by a physician through the agreement, so there is no independent prescribing. Individual prescriptions do not require the physician’s co-signature, but controlled-substance refills and Schedule II prescribing require physician consultation.
Specialty & Telehealth Requirements
Texas sets no NP-specific telehealth collaboration requirement and no specialty-specific requirement for the prescriptive authority agreement. Delegation to providers who are not advanced practice nurses or physician assistants is governed by separate rules.
Source: 22 TAC Chapter 169, Subchapter E
Are there telehealth or telemedicine requirements for NPs in Texas?
No, Texas sets no NP-specific telehealth requirement. The standard collaboration, agreement, and prescribing rules apply regardless of whether care is delivered in person or by telehealth.
Are there specialty-specific requirements for NPs in Texas?
No. There are no specialty-specific requirements for the prescriptive authority agreement, and the delegating physician does not have to match the NP’s specialty.
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