REGULATIONS
Vol. 40 Iss. 3 - September 25, 2023

TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING
BOARD OF PHYSICAL THERAPY
Chapter 20
Forms

REGISTRAR'S NOTICE: Forms used in administering the regulation have been filed by the agency. The forms are not being published; however, online users of this issue of the Virginia Register of Regulations may click on the name of a form with a hyperlink to access it. The forms are also available from the agency contact or may be viewed at the Office of the Registrar of Regulations, 900 East Main Street, 11th Floor, Richmond, Virginia 23219.

Title of Regulation: 18VAC112-20. Regulations Governing the Practice of Physical Therapy.

Agency Contact: Erin Barrett, Regulatory Coordinator, Department of Health Professions, 9960 Mayland Drive, Suite 300, Henrico, VA 23233, telephone (804) 367-4688, or email erin.barrett@dhp.virginia.gov.

FORMS (18VAC112-20)

Application for Licensure by Examination to Practice Physical Therapy as a Physical Therapist or Physical Therapist Assistant - form available online at https://www.dhp.virginia.gov/PhysicalTherapy/physther_forms.htm

Application for Licensure by Examination to Practice Physical Therapy (rev. 3/2023)

Application for Licensure by Endorsement to Practice Physical Therapy as a Physical Therapist or Physical Therapist Assistant - form available online at https://www.dhp.virginia.gov/PhysicalTherapy/physther_forms.htm

Application for Licensure by Endorsement to Practice Physical Therapy (rev. 3/2023)

Application for Reinstatement to Practice Physical Therapy (rev. 3/2023)

Application for Reinstatement after Disciplinary Action (rev. 3/2023)

Checklist and Instructions for Application for Licensure by Endorsement to Practice Physical Therapy (rev. 4/2021)

Checklist and Instructions for Application for Licensure by Endorsement to Practice Physical Therapy (Graduate of a Non-Approved Program) (rev. 4/2021)

Checklist and Instructions for Application for Licensure by Examination to Practice Physical Therapy (rev. 7/2020)

Checklist and Instructions for Application for Licensure by Examination to Practice Physical Therapy (Graduate of a Non-Approved Program) (rev. 7/2020)

Instructions: Reinstatement of Licensure to Practice as a Physical Therapist or Physical Therapist Assistant (rev. 4/2021)

Trainee Application - Statement of Authorization (rev. 7/2020)

Trainee Application - Statement of Authorization (Graduates of a Non-Approved PT or PTA Program Who Need to Complete a Full Time 1,000 Hours of Traineeship) (rev. 7/2020)

Trainee Application - Statement of Authorization (320-hour Traineeship) (rev. 7/2020)

320 Hour Traineeship Completion Form (rev. 7/2020)

Educational Authorization Form (rev. 7/2020)

Continued Competency Activity and Assessment Form (rev. 1/2015)

Continuing Education (CE) Credit Form for Volunteer Practice (rev. 7/2020)

Application for Direct Access Certification (rev. 3/2023)

Instructions - Direct Access Certification by Experience (rev. 11/2020)

Instructions - Direct Access Certification by Transitional Doctorate (rev. 11/2020)

Direct Access Patient Attestation and Medical Release Form (rev. 7/2021)

Name/Address Change Form (rev. 7/2020)

Request for Verification of a Virginia Physical Therapy License (rev. 7/2020)

Application for Licensure by Examination to Practice Physical Therapy (rev. 8/2023)

Application for Licensure by Endorsement to Practice Physical Therapy (rev. 8/2023)

Application for Reinstatement to Practice Physical Therapy (rev. 8/2023)

Application for Reinstatement After Disciplinary Action to Practice Physical Therapy (rev. 8/2023)

Application for Traineeship to Practice Physical Therapy Statement of Authorization (rev. 8/2023)

Application for Unlicensed Graduate Traineeship to Practice Physical Therapy Statement of Authorization (rev. 8/2023)

Completion Form for 320-hour Traineeship to Practice Physical Therapy (rev. 8/2023)

Verification of Physical Therapy Education for Graduates of Approved Programs Only (rev. 8/2023)

Continued Competency Activity and Assessment Form (rev. 8/2023)

Continuing Education (CE) Credit Form for Volunteer Practice (rev. 8/2023)

Application for Direct Access Certification (rev. 8/2023)

Direct Access Patient Attestation and Medical Release Form (rev. 7/2023)

Physical Therapy Name/Address Change Form (rev. 8/2023)

Request for Verification of a Virginia Physical Therapy License (rev. 8/2023)

Application for Reactivation (Inactive to Active) to Practice Physical Therapy (rev. 8/2023)

Out-of-State Practitioner Reporting Form (rev. 7/2023)

VA.R. Doc. No. R24-7676; Filed August 29, 2023