Disclaimer: This material is provided for educational and informational purposes only. It does not constitute legal or medical advice or regulatory guidance. Requirements and interpretations may vary and change over time. Always verify current rules directly with the Texas Medical Board and the Texas State Board of Pharmacy and seek advice from qualified legal counsel before making decisions or taking action.
Executive Summary
- Medical directors must be Texas-licensed MDs/DOs. NPs and PAs require delegation agreements to prescribe.
- Prescriptive Authority Agreements (PAAs) are required for APRNs/PAs prescribing weight loss medications. They must include communication protocols, consultation/referral procedures, and QA plans with chart review, plus meetings.
- Telehealth rules (Tex. Occ. Code §111.005; TMB Chapter 174) require a valid practitioner–patient relationship, adequate records, and a standard of care equivalent to in-person.
- Controlled substances (phentermine, Schedule IV) require DEA registration, Prescription Monitoring Program (PMP) checks, and heightened QA.
- GLP-1 drugs (semaglutide, tirzepatide) are not controlled substances but are under heavy scrutiny — watch for FDA, pharmacy, and board alerts.
- Only physicians can own/control the medical side; lay entities may run MSOs (business operations) but not direct clinical decisions.
Texas has one of the strictest regulatory environments for outpatient care. Weight loss clinics, obesity management programs, and telehealth providers face overlapping rules from:
- Texas Medical Board (TMB): Governs delegation, prescriptive authority, and supervision.
- Texas Occupations Code (Chapters 157 & 111): Sets the framework for delegation and telemedicine.
- Texas State Board of Pharmacy: Regulates dispensing, compounding, and advertising of medications like phentermine or GLP-1s (semaglutide, tirzepatide).
- Corporate Practice of Medicine (CPOM) Doctrine: Bars nonphysicians from controlling medical judgment.
Combine this with the national boom in GLP-1 medications and the expansion of telemedicine, and Texas clinics must tread carefully. A compliant structure isn’t just a formality — it protects licenses, shields physicians and NPs from liability, and builds patient trust.
Quick Compliance Checklist
Physician-owned professional entity (for clinical services) paired with MSO (for business operations).
Medical director = Texas-licensed MD/DO.
Prescriptive Authority Agreement for every NP/PA prescribing weight-loss drugs.
Chart reviews + monthly QA meetings documented.
Telehealth workflows (video visits, e-prescribing, recordkeeping) align with Chapter 174.
DEA + PMP compliance for controlled substances (e.g., phentermine).
Pharmacy compliance for GLP-1 sourcing, compounding, and advertising.
Advertising avoids claims of “miracle cures” or unlicensed providers offering medical care.
The Legal Frame: CPOM and Who Can Be a Medical Director
- A physician-owned professional entity (PC or PLLC) must employ or contract the clinicians.
- A management services organization (MSO) may handle staffing, rent, marketing, or billing, but cannot direct diagnoses, treatments, or prescribing decisions.
- Violating CPOM can trigger fines, board discipline, or even injunctions.
Who Can Be a Medical Director?
Delegation & Prescriptive Authority: The Documents That Matter
Delegation of Medical Acts (Procedures, Labs, IV Therapy
- Covered under TMB rules (22 TAC, Chapter 193).
- Must define scope, training, and supervision.
Prescriptive Authority Agreements
- Required for APRNs/PAs prescribing in Texas (Tex. Occ. Code §157.0512).
- Must be in writing, signed, and include:
- Categories of drugs/devices authorized (e.g., GLP-1s, phentermine).
- Consultation/referral requirements.
- Communication channels (phone/video availability).
- Emergency procedures.
- Quality assurance (chart reviews + periodic meetings).
- Categories of drugs/devices authorized (e.g., GLP-1s, phentermine).
- PAAs must be reviewed at least annually and produced to regulators within three (3) business days if requested.
Delegation Limits
- General cap = 7 APRNs/PAs with delegated prescriptive authority per physician, unless exceptions apply (e.g., facility-based).
Weight Loss Clinics — What Texas Requires
Who Can Prescribe Weight Loss Medications?
- MD/DO: Unrestricted (if licensed).
- NP/PA: Only with written PAA from the supervising physician.
- RNs, estheticians, nutritionists: Cannot prescribe.
Phentermine (Controlled, Schedule IV)
- Requires DEA registration.
- PMP query required before prescribing.
- Document rationale and follow-up visits.
- Avoid “cookie-cutter” scripts; show individualized care.
GLP-1 Medications (Semaglutide, Tirzepatide, etc.)
- Not federally controlled, but Texas pharmacies scrutinize sourcing.
- Compounding: Must comply with FDA/USP standards, and only if shortages justify.
- Delegation: APRNs/PAs may prescribe under PAA if specifically authorized.
IV Therapy, Supplements, Adjuncts
- Each infusion/adjunct protocol should be approved and signed by the physician.
- Staff must have competency checklists + adverse event protocols (e.g., anaphylaxis).
Advertising Rules
- Cannot market nonphysicians as “doctors.”
- Avoid unsubstantiated claims (“lose 30 lbs in 30 days”).
- The Texas AG and TMB have cited clinics for deceptive weight loss advertising.
Telehealth in Texas — Compliance Rules
Practitioner–Patient Relationship (Tex. Occ. Code §111.005)
- Must be established via synchronous video or in-person exam.
- Questionnaires only ≠ valid relationship.
- The standard of care must match in-person.
TMB Chapter 174 Rules
- Document patient identity, consent, diagnosis, and treatment.
- E-prescribing is allowed but must follow the same protocols as in-person.
- Secure records must be accessible for chart review.
Delegation in Telehealth
- PAAs must explicitly cover telemedicine prescribing.
- Define escalation for red-flag cases (psychiatric crises, medication complications).
- Ensure the supervising physician has remote record access for QA.
Telehealth Weight Loss Prescribing
- GLP-1: Permitted via telehealth if practitioner–patient relationship is valid.
- Phentermine: Possible, but riskier due to controlled status; must document PMP checks and careful follow-up.
- Best practice: Require at least one in-person or live video exam before prescribing controlled meds.
Psychiatry & Mental Health Clinics
- PAAs with explicit drug class permissions.
- Stronger QA for controlled meds.
- Emergency escalation protocols documented.
FAQs
Can a nurse practitioner run a weight loss clinic in Texas?
An NP may own the business entity (as MSO) but cannot independently practice medicine. A physician-owned entity must control the medical side, and prescribing requires a PAA.
Can GLP-1 medications be prescribed via telehealth?
Yes, if a valid practitioner–patient relationship exists, documented via video/in-person, and delegation rules are followed.
Is phentermine prescribing allowed via telemedicine?
Technically yes, but only with careful compliance: PMP query, charted rationale, follow-up visits, and full documentation.
Do PAAs need to list specific drugs?
Best practice = yes. At a minimum, they must define categories of drugs/devices authorized or excluded.
Psychiatry & Mental Health Clinics
- Licensed Texas Physicians: Matched to your clinic’s needs (med spa, weight loss, telehealth, psychiatry, general practice).
- Turnkey PAAs: Pre-built templates with communication, QA, and escalation language required by law.
- Quality Assurance Systems: Chart review schedules, meeting templates, and documentation trackers.
- Telehealth Support: Guidance on Chapter 174 workflows, e-prescribing protocols, and HIPAA compliance.
- Drug-Specific Guidance: Phentermine (controlled) vs. GLP-1 (non-controlled), compounding, and advertising rules.
- MSO Alignment: We review agreements to ensure CPOM compliance.
- Licensed Texas Physicians: Matched to your clinic’s needs (med spa, weight loss, telehealth, psychiatry, general practice).
Areas We Serve
Who We Serve
- Nurse Practitioners (NPs) – Including collaborative agreements, prescriptive authority, and regulatory oversight. Our services simplify the process of connecting NPs with medical directors in Texas.
- Registered Nurses (RNs) – Providing oversight for starting medspas, weight loss clinics, and wellness centers. We make it easy to match RNs with collaborating physicians in the metropolitan area.
- Physician Assistants (PAs) – Delivering supervision, protocol evaluation, and compliance support in line with Texas regulations.
- Estheticians in Medical Spas – Enabling safe and compliant advanced aesthetic treatments through physician-approved protocols.
Texas Resources & References
- Texas Medical Board — Board Rules
- Texas Occupations Code Chapter 157 — Delegation & PAAs
- Texas Occupations Code Chapter 111 — Telemedicine
- TMB Rule 174 — Telemedicine practice standards
- Texas State Board of Pharmacy — Compounding & advertising
- Texas Prescription Monitoring Program — Controlled substances checks
Bolton M. Harris, J.D., is a seasoned attorney with a formidable background in criminal law and a focus on healthcare law and compliance. As the in-house legal counsel at Medical Director Co., Harris brings a unique blend of prosecutorial experience and regulatory expertise to support healthcare professionals across Texas. Her career spans roles as a prosecutor in multiple counties and now as a trusted advisor on the legal intricacies of medical practice operations.
Education & Early Career
Bolton Harris completed her undergraduate studies at Southern Methodist University (SMU) in 2013. During her time at SMU, she was not only a dedicated student but also a competitive athlete on the university’s women’s swimming team. She went on to earn her Juris Doctor from Texas A&M University School of Law in 2016 and became a member of the Texas Bar that same year. Armed with a strong academic foundation and discipline honed as a student-athlete, Harris embarked on a career in criminal law immediately after law school.
Prosecutorial Experience in Texas
Bolton Harris began her legal career in public service as a criminal prosecutor. She served as an Assistant District Attorney in multiple jurisdictions, where she quickly rose through the ranks and handled a broad spectrum of cases. Some highlights of her prosecutorial career include:
- Assistant District Attorney, Dallas County, Texas: Prosecuted a high volume of criminal cases in one of the state’s busiest DA offices, gaining extensive trial experience in both misdemeanor and felony courts.
- Assistant District Attorney, Ellis County, Texas: Continued to hone her courtroom advocacy skills, known for meticulous case preparation and a tenacious pursuit of justice on behalf of the community.
- Assistant District Attorney, Navarro County, Texas: Broadened her legal expertise by handling diverse criminal matters in a smaller county, working closely with law enforcement and community leaders to uphold the law.
Through these roles, Harris built a reputation for being a tough but fair advocate. She brought numerous cases to trial and developed an in-depth understanding of the criminal justice system. This distinguished prosecutorial background laid a strong foundation for the next phase of her career in the private sector.
Healthcare Law & Compliance at Medical Director Co.
After her tenure as a prosecutor, Harris shifted her focus to healthcare law, applying her legal acumen to the medical field. She recognized that the same attention to detail and tenacity that served her in criminal law could benefit healthcare providers navigating complex regulations. Embracing this new direction, Harris became well-versed in the intricate laws governing medical practices – from licensing requirements to patient safety and privacy standards – and is passionate about helping practitioners stay compliant.
In her current role as the in-house attorney for Medical Director Co., Bolton Harris oversees all legal and compliance matters for the organization and its clients. Medical Director Co. is a nurse-owned firm that connects nurse practitioners (NPs), physician assistants (PAs), and registered nurses with qualified medical directors and collaborating physicians, offering fast placements and comprehensive compliance support for healthcare practices. Harris ensures that each of these partnerships and clinical ventures adheres to all applicable state and federal laws. She is responsible for drafting and reviewing collaborative practice agreements, advising on regulatory requirements, and providing ongoing legal counsel as clients establish and grow their clinics. Drawing on her prosecutorial eye for risk management, Harris proactively identifies potential legal issues and addresses them before they escalate, giving healthcare professionals peace of mind.
Bolton M. Harris’s multifaceted expertise – spanning high-stakes courtroom litigation to detailed healthcare compliance – makes her a formidable legal ally. Whether advocating in front of a jury or guiding a medical practice through regulatory hurdles, she remains committed to the highest standards of the legal profession. Her blend of courtroom-tested skill and healthcare law knowledge ensures that clients of Medical Director Co. receive elite-level counsel and steadfast protection in an ever-evolving legal landscape.
