REGULATIONS
Vol. 37 Iss. 13 - February 15, 2021

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.

Effective Date: February 15, 2021.

Agency Contact: Elaine Yeatts, Agency Regulatory Coordinator, Department of Health Professions, 9960 Mayland Drive, Henrico, VA 23233, telephone (804) 367-4688, FAX (804) 527-4434, or email elaine.yeatts@dhp.virginia.gov.

Summary of Public Comments and Agency's Response: No public comments were received by the promulgating agency.

FORMS (18VAC112-20)

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

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

Application for Reinstatement to Practice as a Physical Therapist or Physical Therapist Assistant (rev. 4/2017)

Application for Reinstatement after Disciplinary Action (rev. 4/2017)

Checklist and Instructions for Application for Licensure by Endorsement to Practice Physical Therapy (rev. 3/2018)

Checklist and Instructions for Application for Licensure by Endorsement to Practice Physical Therapy (Graduate of a Non-approved Program) (rev. 3/2018)

Checklist and Instructions for Application for Licensure by Examination to Practice Physical Therapy (rev. 3/2018)

Checklist and Instructions for Application for Licensure by Examination to Practice Physical Therapy (Graduate of a Non-Approved Program) (rev. 3/2018)

Instructions - Reinstatement of Licensure to Practice as a Physical Therapist or Physical Therapist Assistant (rev. 7/2017)

Trainee Application Statement of Authorization (graduates awaiting examination results) (rev. 4/2018)

Trainee Application Statement of Authorization (1,000-hour traineeship) (rev. 6/2018)

Trainee Application, Statement of Authorization (320-hour traineeship) (rev. 6/2018)

320 Hour Trainee Completion Form (rev. 6/2018)

Trainee Application Statement of Authorization (160-hour traineeship) (rev. 6/2018)

160 Hour Traineeship Completion Form (rev. 6/2018)

Education Authorization Form (rev. 2/2019)

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

Continuing Education (CE) Credit Form for Volunteer Practice (eff. 2/2018)

Application for Reinstatement to Practice Physical Therapy (rev. 7/2020)

Application for Reinstatement After Disciplinary Action (rev. 7/2020)

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

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

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. 7/2020)

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 - form available online only at https://www.dhp.virginia.gov/PhysicalTherapy/physther_forms.htm

Instructions - Direct Access Certification by Experience (rev. 8/2016)

Instructions - Direct Access Certification by Transitional Doctorate (rev. 6/2015)

Direct Access Patient Attestation and Medical Release Form (eff. 5/2018)

Name/Address Change Form (rev. 6/2018)

Request for Verification of Virginia Physical Therapist License (rev. 6/2018)

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

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

VA.R. Doc. No. R21-6658; Filed January 24, 2021