TMB issues new rules for nonsurgical cosmetic procedures

November 29, 2013 Robin Desrocher

On November 7, 2013, the new TMB rules on standing delegation orders for nonsurgical cosmetic procedures became effective.

The rules apply to procedures such as the injection of a medication or substance for cosmetic purposes; the administration of colonic irrigations; and the use of a prescription medical device for cosmetic purposes. However, laser hair removal procedures performed in accordance with the Texas Health and Safety Code, Chapter 401, Subchapter M, are excluded from this rule.

A few of the physician responsibilities outlined in the rule are:

  • A physician must be appropriately trained, including hands-on training in a procedure, before performing the procedure or delegating the performance of a procedure. The record of training must be kept in the office and available for review upon request by a patient or representative of the TMB.
  • Before authorizing a procedure, a physician or a midlevel practitioner (physician’s assistant or advanced practice registered nurse) acting under the delegation of a physician must:
    • take a history;
    • perform an appropriate physical exam;
    • make an appropriate diagnosis;
    • recommend appropriate treatment;
    • develop a detailed and written treatment plan;
    • obtain the patient's informed consent;
    • provide instructions for emergency care and follow-up care;
    • prepare and maintain an appropriate medical record;
    • have signed and dated protocols;
    • have signed and dated written standing orders; and
    • document the performance of items listed above in the patient's medical record.
  • A physician or midlevel practitioner is on site during the procedure or a delegating physician is available for emergency consultation in the event of an adverse outcome. If the physician considers it necessary, he or she must be able to conduct an emergency appointment with the patient.
  • The physician must ensure there is a quality assurance program pertaining to procedures.
  • A physician may delegate procedures only at a facility in which the physician has either approved in writing the facility’s written protocols or developed his or her own protocols.
  • The physician must ensure that a person performing a procedure has appropriate training.
  • The physician must have a written office protocol for the person performing the procedure to follow.
  • The physician ensures that each person performs each procedure in accordance with the written office protocol.
  • Each person performing a procedure must be readily identified by a name tag or similar means that clearly delineates the identity and credentials of the person.
  • Any time a procedure is performed, at least one person trained in basic life support must be on site.

For more information, please see TMB rules, Chapter 193, standing delegation orders.

About the Author

Robin Desrocher is a Risk Management Manager at TMLT. Robin has more than 28 years of experience in the health care industry, including clinical operations in hospital and outpatient settings, health care administration, and coordinating continuing medical education for physicians and other health care providers. She joined TMLT in 2006. Robin Resrocher can be reached at

More Content by Robin Desrocher
Previous Article
Recovering damaged records

Guidelines for handling damaged or destroyed records.

Next Article
Privacy and security compliance — An ongoing process

As HIPAA rules and protocols change, you must review your existing policies and processes to determine if t...