Delegation is the mechanism that lets a non-physician legally perform a medical procedure in Texas. It is not a formality and it is not a single document you sign once. It is procedure-specific, device-specific, and it has to keep pace with your menu.
On this page
Standing delegation orders versus patient-specific orders
Texas recognizes two paths. Standing delegation orders authorize a category of treatment for patients meeting defined criteria, prepared in advance and applied to qualifying patients. Patient-specific orders authorize treatment for one identified patient.
Most aesthetic practices operate on standing delegation orders, which is what makes the drafting so important. A standing order that is vague, outdated, or does not name the device in use is not doing the job it exists to do.
What a protocol has to actually cover
For each procedure: patient selection criteria and contraindications, the specific device or product including settings where relevant, the technique, expected outcomes, and the response plan for adverse events.
Naming the device matters more than people expect. A protocol written for one laser platform does not automatically cover the one you bought last quarter. Adding equipment means revisiting the protocol before the first treatment, not after.
Who can be delegated to, and for what
A registered nurse can perform delegated aesthetic procedures under written orders, but cannot prescribe. A nurse practitioner or physician assistant can do more, including prescribing, but only under a prescriptive authority agreement with the delegating physician. An esthetician cannot receive delegation for medical procedures at all, regardless of training, because the underlying license does not permit the act.
Getting this wrong is the most common structural error we find, and it is usually well-intentioned. Practices delegate to the person who is best at the procedure rather than the person whose license permits it.
Delegation is procedure-specific and device-specific. A protocol written for the laser you used to own does not cover the one you bought last quarter.
Documented training is part of the requirement
The supervising physician remains responsible for confirming that the person performing the procedure is properly trained for it. That means device-specific training documented in your records, not a general assertion of competence.
If a regulator asks how you established that a particular staff member was qualified to run a particular platform, the answer needs to be a document rather than a recollection.
What changed in 2025
TMB Rule 169.28 closed the ambiguity over what counts as practicing medicine versus a cosmetic service, and HB 3749 tightened prescribing delegation to PAs and APRNs under physician supervision.
The practical effect is that arrangements which were informally tolerated became violations. If your delegation documents predate 2025 and have not been revisited, that is worth doing independently of anything else on this list.
Texas requirement
In Texas, only a physician licensed by the Texas Medical Board, an MD or DO, may serve as a medical director. A nurse practitioner or physician assistant cannot hold the role, though either may perform delegated services under physician supervision.
The medical director’s name and Texas Medical Board license number must be posted in all treatment areas.
Common questions
How often should protocols be reviewed?
Can one protocol cover multiple lasers?
Does the physician need to sign every treatment?
Have your delegation reviewed
Tell us what you offer and who performs it. We will tell you what your protocols need to cover.
This article is general information about Texas regulation and is not legal advice. Entity formation, management services agreements, and corporate practice of medicine analysis should be reviewed by a Texas healthcare attorney.
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