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Texas Medical Director Requirements & Compliance Rules (2025 Guide)

Texas Weight Loss Clinic & Telehealth Compliance Guide

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

  • The medical director must be a Texas-licensed physician (MD/DO) with clinical control over medical decisions. Business people can run operations under a management services organization (MSO), but not the practice of medicine.
  • Physicians can delegate medical acts and may delegate prescriptive authority to APRNs/PAs via a written Prescriptive Authority Agreement. PAAs must include communication, consultation/referral, emergency procedures, and QA (e.g., chart reviews, periodic meetings) and be available to boards upon request. Review at least annually.
  • Texas law sets conditions and limits around prescriptive delegation (e.g., facility exceptions, registration, inspection). Details live in Tex. Occ. Code ch. 157 and TMB rules, Chapter 193. Always confirm your exact configuration against the current rule text.
  • Laser hair removal requires TDLR facility registration and individual technician certifications; device acquisition/use ties back to a physician and written protocols.
  • The widely covered “Botox Party Bill” (SB 378) advanced but was vetoed on June 2, 2025. Even vetoed, it reflects an enforcement trend around who injects and how clinics advertise. Track follow-ons.
Licensed medical director supporting Texas weight loss clinics

Texas combines three realities that make compliance both critical and confusing:

  • 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.

If you’re building or scaling outpatient care in Texas (medspa, telehealth, psychiatry, weight loss, wellness/IV), this hub explains how the pieces fit and links to the source material regulators will expect you to know.

Quick Compliance Checklist

Use this monthly and assign each item to a responsible person (medical director, NP/PA lead, RN lead, clinic manager).

Structure/Ownership: Clinical care flows through a physician-owned professional entity with documented control over medical decisions; any MSO contract avoids lay control of medicine.

Licenses & Credentials: Texas MD/DO (active, unencumbered), plus APRN/PA/RN/LVN licenses, DEA where applicable, TDLR certifications for laser hair removal (facility + personnel).

Delegation Memos & Protocols: Written scope matrices list who can do what (injectables, devices, IV therapy, diagnostics) and under what training. The physician signs off.

Prescriptive Authority Agreements: Written, signed, current; show communication plans, consultation/referral, QA (chart review cadence + meeting frequency), accessible to boards within three business days upon request. Annual review required.

QA Evidence: Chart-review logs, meeting notes, incident tracking, device maintenance logs, competency check-offs. Keep proof handy.

TDLR (if lasers): Facility certificate on wall; technicians carry current cards; consulting/supervising physician contract, device order/prescription, and treatment logs on file.

Marketing Guardrails: No content implying unlicensed practice or lay control of medicine. Titles accurate; claims matched to licensure and delegation. (Even with SB 378 vetoed, enforcement scrutiny remains.)

The Legal Frame: CPOM + Who Can Be a “Medical Director”?

What Is CPOM?

The Corporate Practice of Medicine doctrine bars lay entities/individuals from practicing medicine or controlling medical judgment. The Texas Medical Association’s primer lays out the policy, exceptions, and penalties. In practice, this means clinical decisions, employment of clinicians, and medical records sit with the physician-owned practice; the MSO handles space, staff, marketing, and nonclinical operations under a management contract that avoids clinical control.

Who Can Be a Medical Director?

A Texas-licensed MD/DO in good standing. Specialty is less important than competence for the tasks they delegate and the QA they commit to in writing. The title “medical director” isn’t magic; what matters is the actual control of medicine, the delegation documents, and the QA trail.

Delegation & Prescriptive Authority (APRNs/PAs): The Documents that Matter

Texas splits the concept into two buckets:

  • Delegation of medical acts (who can perform procedures, operate devices, triage complications). The rules live in Title 22, Part 9, Chapter 193. Policies must define qualifications, training, supervision, and physician liability for delegated acts.
  • Delegation of prescribing via a Prescriptive Authority Agreement (PAA). The statute (Tex. Occ. Code §157.0512) requires a written agreement with elements like permitted drugs/devices, communication and consultation plans, emergency procedures, and QA (chart review + periodic meetings). The PAA must be produced to regulators within three business days if requested and reviewed at least annually.  

Practical Tips That Survive Audits

  • Don’t over-promise chart-review numbers or meeting frequency—pick a cadence you’ll actually hit and keep sign-in sheets/minutes.  
  • Keep a PAA index (physician → APRN/PA roster, start dates, renewal dates, scope notes, alternates). When staff change roles or services expand (e.g., RF microneedling), update the PAA and protocols the same week.
  • Make sure every injector/device operator has a signed competency checklist tied to your protocol packet.

Program-Specific Spotlight

Medspas (Injectables, Energy Devices, Skin Procedures)

Texas Medical Director Requirements & Compliance Rules (2025 Guide)
  • Injectables (e.g., onabotulinumtoxinA/Botox®, fillers) are medical procedures. Your delegation memos and protocols should cover patient selection, dosing ranges, product/lot documentation, adverse-event response (e.g., anaphylaxis, vascular occlusion), and escalation. 
  • Laser hair removal is separately regulated by TDLR. You need the facility certificate, qualified personnel at the correct certification tier, a consulting/supervising physician agreement, and board-compliant protocols. Purchase/use of devices requires a physician order; TDLR’s FAQ notes that the consulting-physician contract and protocols satisfy the supervision/prescription elements for each use. 
  • Legislative environment: SB 378 was vetoed on June 2, 2025, but it signaled bipartisan appetite to tighten who injects and how aesthetics is marketed. Expect continued scrutiny even without that specific statute.

Telehealth (Virtual Primary Care, Psychiatry, Weight Management)

  • The physician may delegate and oversee remote APRNs/PAs if documentation, communication channels, and QA are real (not theoretical). Ensure your PAA and delegation memos account for remote settings and how records are accessed for chart review. (Texas Statutes, Legal Information Institute)

  • Prescribing via telemedicine must satisfy both Texas requirements and the standard of care; align video workflows, informed consent, and e-prescribing policies with your PAA language. (Legal Information Institute)

Psychiatry & Behavioral Health

  • Collaboration follows the same §157.0512 framework. Add safeguards for controlled substances (DEA registration, PMP checks), emergency plans for crisis escalation, and interval case reviews documented in your QA minutes. (Texas Statutes)

Weight Loss & Wellness (GLP-1s, Phentermine, IV Therapy)

  • Update your formulary section in the PAA to reflect exactly which agents/classes are authorized or excluded. Define baseline labs, follow-up intervals, and adverse-event response. If you run IV therapy, create device/medication logs and anaphylaxis protocols with staff drills. (Texas Statutes, Legal Information Institute)

The Paperwork Texas Actually Asks to See

When there’s a complaint, payer audit, or surprise inspection, investigators ask for documents—not intentions. Your “binder” (digital is fine) should include:
  • Entity & Governance: Physician-owned professional entity documents; MSO agreement showing business support without clinical control. (Texas Medical Association)

  • Licenses & Registrations: MD/DO license, APRN/PA/RN/LVN licenses, DEA if applicable, TDLR facility certificate, and technician credentials for laser hair removal. (TDLR)

  • PAAs: Signed and current, with communication/consultation, emergency plans, and QA (chart-review numbers, meeting cadence). Keep annual reviews and on-request delivery (three business days) top of mind. (Texas Statutes)

  • Delegation & Scope Matrix: Who may perform each procedure; prerequisites, direct-observation sign-offs, and renewal dates. (Legal Information Institute)

  • Protocols & Consents: Procedure-specific packets (injectables, devices, IV therapy) with complication algorithms and crash-cart contents. (Legal Information Institute)

  • Laser Folder (if applicable): Facility registration, technician tiers, consulting-physician agreement, device order/prescription, treatment logs, and CE records. (TDLR)

  • QA Trail: Chart-review lists with findings/remediations, monthly meeting agendas/minutes, and incident log with corrective actions. (Texas Statutes)

  • Marketing Approvals: Sign-off process to avoid implying unlicensed practice or lay control; keep a copy of your titles/credentials style guide. Helpful if lawmakers revive SB-378-style provisions later. (LegiScan)

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.

Avoid These Common Texas Mistakes

  1. Treating “medical director” as a title only. If the physician doesn’t actually control medical policies, delegation, and QA, you’ve set up a CPOM problem. The MSO can’t steer clinical judgment. (Texas Medical Association)

  2. Running on stale PAAs. Add a new modality? Change injector mix? Update the PAA and delegation memos the same week. Review annually and log the review date/signatures. (Texas Statutes)

  3. Under-documenting QA. If you can’t produce meeting minutes and chart-review lists, regulators assume QA isn’t happening. Pick a realistic cadence and stick to it. (Texas Statutes)

  4. Treating laser hair removal as “just cosmetic.” TDLR has its own regime: facility certificate, technician credentials, consulting physician, device order, and protocols. (TDLR)

  5. Ambiguous marketing. Titles like “doctor-led team” can backfire if injectors aren’t licensed for what’s implied. Keep claims tight and mapped to delegation policies; the 2025 SB 378 debate shows where regulators’ attention is headed. (LegiScan)

Step-by-Step: Building a Defensible Texas Setup (30/60/90 Plan)

Days 1–30: Foundation

  • Diagnose the structure: Confirm a physician-owned professional entity controls medicine; review MSO contract for decision-rights language. (Texas Medical Association)
  • License inventory: MD/DO, APRN/PA/RN/LVN, DEA as needed; TDLR facility + technician status for laser hair removal. Close gaps first. (TDLR)
  • Paper the program: Draft or refresh delegation memos and procedure protocols; finalize PAAs with communication, consultation, emergency, and QA sections. (Texas Statutes, Legal Information Institute)

Days 31–60: QA in Motion

  • Start the cadence: Hold your first QA meeting; pick a sustainable chart-review number; log findings and remediations. (Texas Statutes)
  • Mock inspections: One pass against TMB delegation/QA expectations; another against TDLR laser requirements if applicable. Fix findings within two weeks. (TDLR, Legal Information Institute)
  • Marketing scrub: Update website and ads to align with licensure/delegation; publish a public “Patient Safety & Oversight” page. Good optics with boards. (LegiScan)

Days 61–90: Harden & Scale

  • Competency proof: Direct-observation sign-offs for injectors/device operators; keep renewal reminders. (Legal Information Institute)
  • Audit access: Ensure your medical director can remotely access records for chart review within three business days of any board request. (Texas Statutes)
  • Service expansion protocol: New modality requires: training plan, device/protocol packet, updated PAA/delegation, and marketing review before launch. (Legal Information Institute)

FAQs

Can a nonphysician own a clinic in Texas?

Yes, but not the practice of medicine. Use a physician-owned professional entity for medical services and an MSO for business operations. Contract language must keep medical judgment with the physician. (Texas Medical Association)

An MD/DO licensed in Texas. Specialty matters less than competence and willingness to own delegation/QA obligations and be available to the team. (Texas Medical Board)

Written scope of drugs/devices authorized or excluded, communication and consultation rules, emergency procedures, and quality-assurance activities like chart reviews and periodic meetings; keep it available to regulators within three business days and review at least annually. (Texas Statutes)

Yes—TDLR runs that program. You need facility registration, properly credentialed technicians, a consulting/supervising physician agreement, and a device order/prescription with protocols for each use. (TDLR)

No. The high-profile SB 378 bill that aimed to tighten injectable rules was vetoed on June 2, 2025. But it spotlights an enforcement trend: expect regulators to scrutinize who injects and how clinics advertise. (LegiScan)

How Medical Director Co. Fits into Texas Compliance

Medical Director Co. helps you do more than “check boxes.” We provide:

  • Texas-licensed physicians who understand outpatient models (medspa, telehealth, psych, weight loss).
  • Turnkey PAAs with the required Texas elements (communication/consultation, emergency, QA) and workflows to keep them current.
  • QA cadence you’ll actually meet: chart-review volumes, monthly agenda templates, and documentation trails regulators respect.
  • TDLR laser setup (if needed): facility registration checklist, technician credential ladder, consulting-physician agreement language, and device/order protocol packet.
  • Structure alignment: We sanity-check MSO agreements and governance so the physician retains clinical control in line with CPOM.
  • Legislative/watch updates: We track rule reorganizations at TMB and legislative shifts (e.g., post-SB-378 policy moves) and tell you what to change in your protocols before it’s an issue.
Find a Licensed Texas Medical Director for Your Clinic Today

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We provide licensed medical directors and compliance support for clinics across Texas — including major metros:
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