TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING
BOARD OF PHYSICAL THERAPY
Final Regulation
Title of Regulation:
18VAC112-20. Regulations Governing the Practice of Physical Therapy (amending
18VAC112-20-10, 18VAC112-20-40, 18VAC112-20-50, 18VAC112-20-60, 18VAC112-20-65,
18VAC112-20-70, 18VAC112-20-90, 18VAC112-20-120, 18VAC112-20-131,
18VAC112-20-135, 18VAC112-20-136, 18VAC112-20-140, 18VAC112-20-150; adding
18VAC112-20-160, 18VAC112-20-170, 18VAC112-20-180, 18VAC112-20-190, 18VAC112-20-200).
Statutory Authority: § 54.1-2400 and
Chapter 34.1 (§ 54.1-3473 et seq.) of Title 54.1 of the Code of Virginia.
Effective Date: September 30, 2009.
Agency Contact: Lisa R. Hahn, Executive
Director, Board of Physical Therapy, 9960 Mayland Drive, Suite 300, Richmond,
VA 23233, telephone (804) 367-4674, FAX (804) 527-4413, or email
ptboard@dhp.virginia.gov.
Summary:
The amendments clarify
certain definitions and requirements for practice by physical therapists,
simplify regulations for trainees, specify the additional training or course
work required to retake the examination after three failures, add evidence of
competency for licensure by endorsement, clarify the responsibilities of a
physical therapist in the evaluation and discharge of a patient, modify the
requirements for renewal or reinstatement of licensure, and add provisions on
standards of professional practice and grounds for unprofessional conduct.
Summary of Public Comments and Agency's
Response: A
summary of comments made by the public and the agency's response may be
obtained from the promulgating agency or viewed at the office of the Registrar
of Regulations.
Part I
General Provisions
18VAC112-20-10. Definitions.
In addition to the words and
terms defined in § 54.1-3473 of the Code of Virginia, the following words and
terms when used in this chapter shall have the following meanings unless the
context clearly indicates otherwise:
"Active practice"
means a minimum of 160 hours of professional practice as a physical therapist
or physical therapist assistant within the 24-month period immediately
preceding renewal. Active practice may include supervisory, administrative,
educational or consultative activities or responsibilities for the delivery of
such services.
"Approved program"
means an educational program accredited by the Commission on Accreditation in
Physical Therapy Education of the American Physical Therapy Association.
"CLEP" means the
College Level Examination Program.
"Contact hour"
means 60 minutes of time spent in continuing learning activity exclusive of
breaks, meals or vendor exhibits.
"Direct
supervision" means a physical therapist or a physical therapist assistant
is physically present and immediately available and is fully responsible for
the physical therapy tasks or activities being performed.
"Discharge" means
the discontinuation of interventions in [ a single an ] episode
of care that have been provided in an unbroken sequence [ in a
single practice setting ] and related to the physical therapy
interventions for a given condition or problem.
"Evaluation" means
the examination, assessment or screening of a patient a process in
which the physical therapist makes clinical judgments based on data gathered
during an examination [ or screening ] in order to plan
and implement a treatment intervention, provide preventive care, reduce risks
of injury and impairment, or provide for consultation.
"Face-to-face"
means learning activities or courses obtained in a group setting or through
interactive, real-time technology.
"FCCPT" means the
Foreign Credentialing Commission on Physical Therapy.
"General
supervision" means a physical therapist shall be available for
consultation.
"National
examination" means the examinations developed and administered by the
Federation of State Boards of Physical Therapy and approved by the board for
licensure as a physical therapist or physical therapist assistant.
"Support
personnel" means a person who is performing designated routine tasks
related to physical therapy under the direction and supervision of a physical
therapist or physical therapist assistant within the scope of this chapter.
"TOEFL" means the
Test of English as a Foreign Language.
"Trainee" means a
person seeking licensure as a physical therapist or physical therapist
assistant who is undergoing a traineeship.
1. "Foreign educated
trainee" means a physical therapist or physical therapist assistant who
was educated outside the United States and did not graduate from an approved
program and who is seeking licensure to practice in Virginia.
2. "Inactive practice
trainee" means a physical therapist or physical therapist assistant who
has previously been licensed and has not practiced for at least 320 hours
within the past four years and who is seeking licensure or relicensure in Virginia.
3. "Unlicensed graduate
trainee" means a graduate of an approved physical therapist or physical
therapist assistant program who has not taken the national examination or who
has taken the examination but not yet received a license from the board.
"Traineeship"
means a period of active clinical practice during which an unlicensed applicant
for licensure as a physical therapist or physical therapist assistant works
under the direct supervision of a physical therapist approved by the board.
"TSE" means the Test
of Spoken English.
"Type 1" means
face-to face continuing learning activities offered by an approved organization
as specified in 18VAC112-20-131.
"Type 2" means
continuing learning activities which may or may not be offered by an approved
organization but shall be activities considered by the learner to be beneficial
to practice or to continuing learning.
18VAC112-20-40. Education
requirements: graduates of approved programs.
A. An applicant for
licensure who is a graduate of an approved program shall submit documented
evidence of his graduation from such a program with the required application
and fee.
B. If an applicant is a
graduate of an approved program located outside of the United States or Canada,
he shall provide proof of proficiency in the English language by passing TOEFL
and TSE or the TOEFL iBT, the Internet-based tests of listening, reading,
speaking and writing by a score determined by the board or an equivalent
examination approved by the board. TOEFL iBT or TOEFL and TSE may be
waived upon evidence of English proficiency that the applicant's
physical [ therapist assistant therapy ] program
was taught in English or that the native tongue of the applicant's nationality
is English.
18VAC112-20-50. Education
requirements: graduates of schools not approved by an accrediting agency
approved by the board.
A. An applicant for initial
licensure as a physical therapist who is a graduate of a school not approved by
an accrediting agency approved by the board shall submit the required
application and fee and provide documentation of the physical therapist's
certification by a report from the FCCPT or of the physical therapist
eligibility for licensure as verified by a report from any other credentialing
agency approved by the board that substantiates that the physical therapist has
been evaluated in accordance with requirements of subsection B of this section.
B. The board shall only
approve a credentialing agency that:
1. Utilizes the Coursework Evaluation Tool
for Foreign Educated Physical Therapists of the Federation of State Boards of
Physical Therapy and utilizes original source documents to establish
substantial equivalency to an approved physical therapy program;
2. Conducts a review of any license or
registration held by the physical therapist in any country or jurisdiction to
ensure that the license or registration is current and unrestricted or was
unrestricted at the time it expired or was lapsed; and
3. Verifies English language proficiency by
passage of the TOEFL and TSE examination or the TOEFL iBT, the
Internet-based tests of listening, reading, speaking and writing or by
review of other evidence of English proficiency that the
applicant's physical therapy program was taught in English or that the native
tongue of the applicant's nationality is English.
C. An applicant for
licensure as a physical therapist assistant who is a graduate of a school not
approved by the board shall submit with the required application and fee the
following:
1. Proof of proficiency in the English
language by passing TOEFL and TSE or the TOEFL iBT, the Internet-based tests
of listening, reading, speaking and writing by a score determined by the
board or an equivalent examination approved by the board. TOEFL iBT or
TOEFL and TSE may be waived upon evidence of English proficiency that
the applicant's physical therapist assistant program was taught in English or
that the native tongue of the applicant's nationality is English.
2. A copy of the original certificate or
diploma that has been certified as a true copy of the original by a notary
public, verifying his graduation from a physical therapy curriculum. If the
certificate or diploma is not in the English language, submit either:
a. An English translation of such certificate
or diploma by a qualified translator other than the applicant; or
b. An official certification in English from
the school attesting to the applicant's attendance and graduation date.
3. Verification of the equivalency of the
applicant's education to the educational requirements of an approved program
for physical therapist assistants from a scholastic credentials service
approved by the board.
D. An applicant for initial
licensure as a physical therapist or a physical therapist assistant who is not
a graduate of an approved program shall also submit verification of having
successfully completed a full-time 1,000-hour traineeship as a "foreign
educated trainee" under the direct supervision of a licensed physical
therapist.
1. The traineeship shall be in
a facility that serves as an education facility for students enrolled in an
accredited program educating physical therapists in Virginia and is approved by
the board accordance with requirements in 18VAC112-20-140.
1. It shall be the
responsibility of the foreign educated trainee to make the necessary
arrangements for his training with the director of physical therapy or the
director's designee at the facility selected by the trainee.
2. The physical therapist
supervising the foreign educated trainee shall submit a completed physical therapy
or physical therapist assistant clinical performance instrument approved by the
board.
3. If the traineeship is not
successfully completed, the president of the board or his designee shall
determine if a new traineeship shall commence. If it is determined by the board
that a new traineeship shall not commence, then the application for licensure
shall be denied.
4. The second traineeship
may be served under a different supervising physical therapist and may be
served in a different organization than the initial traineeship. If the second
traineeship is not successfully completed, as determined by the supervising
physical therapist, then the application for licensure shall be denied.
5. 2. The traineeship
requirements of this part may be waived if the applicant for a license can
verify, in writing, the successful completion of one year of clinical physical
therapy practice as a licensed physical therapist or physical therapist
assistant in the United States, its territories, the District of Columbia, or Canada,
equivalent to the requirements of this chapter.
18VAC112-20-60. Requirements
for licensure by examination.
A. Every applicant for
initial licensure by examination shall submit:
1. Documentation of having met the
educational requirements specified in 18VAC112-20-40 or 18VAC112-20-50;
2. The required application, fees and
credentials to the board; and
3. Documentation of passage of the national
examination as prescribed by the board.
B. If an applicant fails the
national examination three times, he shall apply for approval to sit for any
subsequent examination by submission of evidence satisfactory to the board of
having successfully completed additional clinical training or course work in
the deficiency areas of the examination the following requirements:
1. Provide the board with a
copy of the deficiency report from the examination;
2. Review areas of
deficiency with the applicant's physical therapy educational program and
develop a plan, which may include additional clinical training or coursework,
to address deficiency areas; and
3. Take an examination
review course and the practice examination.
18VAC112-20-65. Requirements
for licensure by endorsement.
A. A physical therapist or
physical therapist assistant who holds a current, unrestricted license in the
United States, its territories, the District of Columbia, or Canada may be
licensed in Virginia by endorsement.
B. An applicant for
licensure by endorsement shall submit:
1. Documentation of having met the
educational requirements prescribed in 18VAC112-20-40 or 18VAC112-20-50. In
lieu of meeting such requirements, an applicant may provide evidence of
clinical practice during the five years immediately preceding application for
licensure in Virginia with a current, unrestricted license issued by another
U.S. jurisdiction;
2. The required application, fees, and
credentials to the board; and
3. A current report from the
Healthcare Integrity and Protection Data Bank (HIPDB) and a current report from
the National Practitioner Data Bank (NPDB);
4. Evidence of completion of
15 hours of continuing education for each year in which the applicant held a
license in another U.S. jurisdiction, or 60 hours obtained within the past four
years; and
3. 5. Documentation of
passage of an examination equivalent to the Virginia examination at the time of
initial licensure or documentation of passage of an examination required by
another state at the time of initial licensure in that state and active,
clinical practice with a current, unrestricted license for at least five years
prior to applying for licensure in Virginia.
For the purpose of this
subsection, active, clinical practice shall mean at least 2,500 hours of
patient care over a five-year period.
C. A physical therapist or
physical therapist assistant seeking licensure by endorsement who has not
actively practiced physical therapy for at least 160 320 hours
within the two four years immediately preceding his application
for licensure shall first successfully complete a 480-hour 480 hours
in a traineeship as specified by subsection B of in accordance
with requirements in 18VAC112-20-140.
18VAC112-20-70. Traineeship
for unlicensed graduate scheduled to sit for the national examination.
A. Upon approval of the
president of the board or his designee, an unlicensed graduate trainee in
Virginia may be employed as a trainee under the direct supervision
of a licensed physical therapist until the results of the national examination
are received.
B. The traineeship, which
shall be in accordance with requirements in 18VAC112-20-140, shall
terminate two working days following receipt by the candidate of the licensure
examination results.
C. The unlicensed graduate
may reapply for a new traineeship while awaiting to take the next examination. A
new traineeship shall not be approved for more than one year following the
receipt of the first examination results.
18VAC112-20-90. General
responsibilities.
A. The physical therapist
shall be responsible for managing all aspects of the physical therapy care of
each patient and shall provide:
1. The initial evaluation for each patient
and its documentation in the patient record; and
2. Periodic evaluations [ prior to
patient discharge ], including documentation of the patient's response
to therapeutic intervention.
3. The documented [ discharge
status ] of the patient [ at the time of
discharge ] , including the response to therapeutic intervention
[ at the time of discharge ].
B. The physical therapist
shall communicate the overall plan of care to the patient or his legally authorized
representative and shall also communicate with a referring doctor of medicine,
osteopathy, chiropractic, podiatry, or dental surgery, nurse practitioner or
physician assistant to the extent required by § 54.1-3482 of the Code of
Virginia.
C. A physical therapist
assistant may assist the physical therapist in performing selected components
of physical therapy intervention to include treatment, measurement and data
collection, but not to include the performance of an evaluation as defined in
18VAC112-20-10.
D. A physical therapist
assistant's visits to a patient may be made under general supervision.
E. A physical therapist
providing services with a direct access certification as specified in §
54.1-3482 of the Code of Virginia shall utilize the Direct Access Patient
Attestation and Medical Release Form prescribed by the board or otherwise
include in the patient record the information, attestation and written consent
required by subsection B of § 54.1-3482 of the Code of Virginia.
18VAC112-20-120. Responsibilities
to patients.
A. The initial patient visit
shall be made by the physical therapist for evaluation of the patient and
establishment of a plan of care.
B. The physical therapist
assistant's first visit with the patient shall only be made after verbal or
written communication with the physical therapist regarding patient status and
plan of care. Documentation of such communication shall be made in the
patient's record.
C. Documentation of physical
therapy interventions shall be recorded on a patient's record by the physical
therapist or physical therapist assistant providing the care.
D. The physical therapist
shall reevaluate the patient as needed, but not less than according to the
following schedules:
1. For inpatients in hospitals as defined in
§ 32.1-123 of the Code of Virginia, it shall be not less than once every seven
consecutive days.
2. For patients in other settings, it shall
be not less than one of 12 visits made to the patient during a 30-day period,
or once every 30 days from the last evaluation, whichever occurs first.
Failure to abide by this
subsection due to the absence of the physical therapist in case of illness,
vacation, or professional meeting, for a period not to exceed five consecutive
days, will not constitute a violation of these provisions.
E. The physical therapist
shall be responsible for ongoing involvement in the care of the patient to
include regular communication with a physical therapist assistant regarding the
patient's plan of treatment.
18VAC112-20-131. Continued
competency requirements for renewal of an active license.
A. In order to renew an
active license biennially after December 31, 2003, a physical therapist
or a physical therapist assistant shall complete at least 30 contact hours of
continuing learning activities within the two years immediately preceding
renewal. In choosing continuing learning activities or courses, the licensee
shall consider the following: (i) the need to promote ethical practice, (ii) an
appropriate standard of care, (iii) patient safety, (iv) application of new
medical technology, (v) appropriate communication with patients, and (vi)
knowledge of the changing health care system.
B. To document the required
hours, the licensee shall maintain the Continued Competency Activity and
Assessment Form that is provided by the board and that shall indicate
completion of the following:
1. A minimum of 15 of the contact hours
required for physical therapists and 10 of the contact hours required for
physical therapist assistants shall be in Type 1 face-to-face courses. For the
purpose of this section, "course" means an organized program of
study, classroom experience or similar educational experience that is directly
related to the clinical practice of physical therapy and approved or provided
by one of the following organizations or any of its components:
a. The Virginia Physical Therapy Association;
b. The American Physical Therapy Association;
c. Local, state or federal government
agencies;
d. Regionally accredited colleges and universities;
e. Health care organizations accredited by
the Joint Commission on Accreditation of Healthcare Organizations (JCAHO);
f. The American Medical Association -
Category I Continuing Medical Education course; and
g. The National Athletic Trainers Association.
2. No more than 15 of the contact hours
required for physical therapists and 20 of the contact hours required for
physical therapist assistants may be Type 2 activities or courses, which may or
may not be offered by an approved organization but which shall be related to
the clinical practice of physical therapy. Type 2 activities may include but
not be limited to consultation with colleagues, independent study, and research
or writing on subjects related to practice.
3. Documentation of specialty certification
by the American Physical Therapy Association may be provided as evidence of
completion of continuing competency requirements for the biennium in which
initial certification or recertification occurs.
4. Documentation of
graduation from a transitional doctor of physical therapy program may be
provided as evidence of completion of continuing competency requirements for
the biennium in which the physical therapist was awarded the degree.
C. A licensee shall be
exempt from the continuing competency requirements for the first biennial
renewal following the date of initial licensure by examination in
Virginia.
D. The licensee shall retain
his records on the completed form with all supporting documentation for a
period of four years following the renewal of an active license.
E. The licensees selected in
a random audit conducted by the board shall provide the completed Continued
Competency Activity and Assessment Form and all supporting documentation within
30 days of receiving notification of the audit.
F. Failure to comply with
these requirements may subject the licensee to disciplinary action by the
board.
G. The board may grant an
extension of the deadline for continuing competency requirements for up to one
year for good cause shown upon a written request from the licensee prior to the
renewal date.
H. The board may grant an
exemption for all or part of the requirements for circumstances beyond the
control of the licensee, such as temporary disability, mandatory military
service, or officially declared disasters.
I. Physical therapists
holding certification to provide direct access without a referral shall include
four contact hours as part of the required 30 contact hours of continuing
education in courses related to clinical practice in a direct access setting.
18VAC112-20-135. Inactive
license.
A. A physical therapist or
physical therapist assistant who holds a current, unrestricted license in
Virginia shall, upon a request on the renewal application and submission of the
required renewal fee of $70 for a physical therapist and $35 for a physical
therapist assistant, be issued an inactive license. From January 1, 2006,
through December 31, 2006, the inactive renewal fee shall be $30 for a physical
therapist and $15 for a physical therapist assistant.
1. The holder of an inactive license shall
not be required to meet active practice requirements.
2. An inactive licensee shall not be entitled
to perform any act requiring a license to practice physical therapy in
Virginia.
B. A physical therapist or
physical therapist assistant who holds an inactive license may reactivate his
license by:
1. Paying the difference between the renewal
fee for an inactive license and that of an active license for the biennium in
which the license is being reactivated; and
2. Providing proof of:
a. Active practice hours in another
jurisdiction equal to those required for renewal of an active license in
Virginia for the period in which the license has been inactive. If the inactive
licensee does not meet the requirement for active practice, the license may be
reactivated by meeting the completing 480 hours in a traineeship that
meets the requirements prescribed in 18VAC112-20-140; and
b. Completion of the number of continuing
competency hours required for the period in which the license has been
inactive, not to exceed four years.
18VAC112-20-136.
Reinstatement requirements.
A. A physical therapist or
physical therapist assistant whose Virginia license is lapsed for two years or
less may reinstate his license by payment of the renewal and late fees as set
forth in 18VAC112-20-150 and completion of continued competency requirements as
set forth in 18VAC112-20-131.
B. A physical therapist or
physical therapist assistant whose Virginia license is lapsed for more than
two years and who is seeking reinstatement shall:
1. Practice physical therapy in another
jurisdiction for at least 320 hours within the four years immediately preceding
applying for reinstatement or successfully complete 480 hours as an inactive
practice trainee as specified in 18VAC112-20-140; and
2. Complete the number of continuing
competency hours required for the period in which the license has been lapsed,
not to exceed four years.
18VAC112-20-140. Traineeship
required requirements.
The 480 hours of
traineeship [ : (i) ] shall be in a facility that [ (i) ]
serves as a clinical education facility for students enrolled in an accredited
program educating physical therapists in Virginia, (ii) is approved by the
board, and (iii) is under the direction and supervision of a licensed physical
therapist.
1. The physical therapist supervising the
inactive practice trainee shall submit a report to the board at the end of the 480
required number of hours on forms supplied by the board.
2. If the traineeship is not successfully
completed at the end of the 480 required hours, as determined by
the supervising physical therapist, the president of the board or his designee
shall determine if a new traineeship shall commence. If the president of the
board determines that a new traineeship shall not commence, then the
application for licensure shall be denied.
3. The second traineeship may be served under
a different supervising physical therapist and may be served in a different
organization than the initial traineeship. If the second traineeship is not
successfully completed, as determined by the supervising physical therapist,
then the application for licensure shall be denied.
18VAC112-20-150. Fees.
A. Unless otherwise
provided, fees listed in this section shall not be refundable.
B. Licensure by examination.
1. The application fee shall be $140 for a
physical therapist and $100 for a physical therapist assistant.
2. The fees for taking all required
examinations shall be paid directly to the examination services.
C. Licensure by endorsement.
The fee for licensure by endorsement shall be $140 for a physical therapist and
$100 for a physical therapist assistant.
D. Licensure renewal and
reinstatement.
1. The fee for active license renewal for a
physical therapist shall be $135 and for a physical therapist assistant shall
be $70 and shall be due by December 31 in each even-numbered year. From
January 1, 2006, through December 31, 2006, the fee for active license renewal
fee shall be $60 for a physical therapist and $30 for a physical therapist
assistant.
2. A fee of $25 for a physical therapist
assistant and $50 for a physical therapist for processing a late renewal within
one renewal cycle shall be paid in addition to the renewal fee.
3. The fee for reinstatement of a license
that has expired for two or more years shall be $180 for a physical therapist
and $120 for a physical therapist assistant and shall be submitted with an
application for licensure reinstatement.
E. Other fees.
1. The fee for an application for
reinstatement of a license that has been revoked shall be $1,000; the fee
for an application for reinstatement of a license that has been suspended shall
be $500.
2. The fee for a duplicate license shall be
$5, and the fee for a duplicate wall certificate shall be $15.
3. The fee for a returned check shall be $35.
4. The fee for a letter of good
standing/verification to another jurisdiction shall be $10.
F. Direct access
certification fees.
1. The application fee shall be $75 for a
physical therapist to obtain certification to provide services without a
referral.
2. The fee for renewal on a direct access
certification shall be $35 and shall be due by December 31 in each
even-numbered year.
3. A fee of $15 for processing a late renewal
of certification within one renewal cycle shall be paid in addition to the
renewal fee.
Part IV
Standards of Practice
18VAC112-20-160.
Requirements for patient records.
A. Practitioners shall
comply with provisions of § 32.1-127.1:03 of the Code of Virginia related to
the confidentiality and disclosure of patient records.
B. Practitioners shall
provide patient records to another practitioner or to the patient or his
personal representative in a timely manner in accordance with provisions of §
32.1-127.1:03 of the Code of Virginia.
C. Practitioners shall
properly manage and keep timely, accurate, legible and complete patient
records.
D. Practitioners who are
employed by a health care institution, school system or other entity, in which
the individual practitioner does not own or maintain his own records, shall
maintain patient records in accordance with the policies and procedures of the
employing entity.
E. Practitioners who are
self-employed or employed by an entity in which the individual practitioner
does own and is responsible for patient records shall:
1. Maintain a patient record
for a minimum of six years following the last patient encounter with the
following exceptions:
a. Records of a minor child
shall be maintained until the child reaches the age of 18 or becomes
emancipated, with a minimum time for record retention of six years from the
last patient encounter regardless of the age of the child;
b. Records that have
previously been transferred to another practitioner or health care provider or
provided to the patient or his personal representative; or
c. Records that are required
by contractual obligation or federal law may need to be maintained for a longer
period of time.
2. From (six months from the
effective date of the regulation), post information or in some manner inform
all patients concerning the time frame for record retention and destruction.
Patient records shall only be destroyed in a manner that protects patient
confidentiality, such as by incineration or shredding.
F. When a practitioner is
closing, selling or relocating his practice, he shall meet the requirements of
§ 54.1-2405 of the Code of Virginia for giving notice that copies of records
can be sent to any like-regulated provider of the patient's choice or provided
to the patient.
18VAC112-20-170.
Confidentiality and practitioner-patient communication.
A. A practitioner shall not
willfully or negligently breach the confidentiality between a practitioner and
a patient. A breach of confidentiality that is required or permitted by applicable
law or beyond the control of the practitioner shall not be considered negligent
or willful.
B. Communication with
patients.
1. Except as provided in §
32.1-127.1:03 F of the Code of Virginia, a practitioner shall accurately
present information to a patient or his legally authorized representative in
understandable terms and encourage participation in decisions regarding the
patient's care.
2. A practitioner shall not
deliberately make a false or misleading statement regarding the practitioner's
skill or the efficacy or value of a treatment or procedure provided or directed
by the practitioner in the treatment of any disease or condition.
3. Before any invasive
procedure is performed, informed consent shall be obtained from the patient and
documented in accordance with the policies of the health care entity.
Practitioners shall inform patients of the risks, benefits, and alternatives of
the recommended invasive procedure that a reasonably prudent practitioner in
similar practice in Virginia would tell a patient. In the instance of a minor
or a patient who is incapable of making an informed decision on his own behalf
or is incapable of communicating such a decision due to a physical or mental
disorder, the legally authorized person available to give consent shall be
informed and the consent documented.
4. Practitioners shall
adhere to requirements of § 32.1-162.18 of the Code of Virginia for obtaining
informed consent from patients prior to involving them as subjects in human
research with the exception of retrospective chart reviews.
C. Termination of the
practitioner/patient relationship.
1. The practitioner or the
patient may terminate the relationship. In either case, the practitioner shall
make the patient record available, except in situations where denial of access
is allowed by law.
2. A practitioner shall not
terminate the relationship or make his services unavailable without documented
notice to the patient that allows for a reasonable time to obtain the services
of another practitioner.
18VAC112-20-180.
Practitioner responsibility.
A. A practitioner shall not:
1. Perform procedures or
techniques that are outside the scope of his practice or for which he is not
trained and individually competent;
2. Knowingly allow persons
under his supervision to jeopardize patient safety or provide patient care
outside of such person's scope of practice or area of responsibility.
Practitioners shall delegate patient care only to persons who are properly
trained and supervised;
3. Engage in an egregious
pattern of disruptive behavior or interaction in a health care setting that
interferes with patient care or could reasonably be expected to adversely
impact the quality of care rendered to a patient; or
4. Exploit the
practitioner/patient relationship for personal gain.
B. A practitioner shall not
knowingly and willfully solicit or receive any remuneration, directly or
indirectly, in return for referring an individual to a facility or institution
as defined in § 37.2-100 of the Code of Virginia, or hospital as defined in §
32.1-123 of the Code of Virginia.
Remuneration
shall be defined as compensation, received in cash or in kind, but shall not
include any payments, business arrangements, or payment practices allowed by [ Title
] 42 [ , USC ] § 1320a-7b(b) [ of the United
States Code, as amended, ] or any regulations promulgated thereto.
C. A practitioner shall not
willfully refuse to provide information or records as requested or required by
the board or its representative pursuant to an investigation or to the enforcement
of a statute or regulation.
D. A practitioner shall
report any disciplinary action taken by a physical therapy regulatory board in
another jurisdiction within 30 days of final action.
18VAC112-20-190. Sexual
contact.
A. For purposes of §
54.1-3483 (10) of the Code of Virginia and this section, sexual contact
includes, but is not limited to, sexual behavior or verbal or physical behavior
that:
1. May reasonably be
interpreted as intended for the sexual arousal or gratification of the
practitioner, the patient, or both; or
2. May reasonably be
interpreted as romantic involvement with a patient regardless of whether such
involvement occurs in the professional setting or outside of it.
B. Sexual contact with a
patient.
1. The determination of when
a person is a patient for purposes of § 54.1-3483 (10) of the Code of Virginia
is made on a case-by-case basis with consideration given to the nature, extent,
and context of the professional relationship between the practitioner and the
person. The fact that a person is not actively receiving treatment or
professional services from a practitioner is not determinative of this issue. A
person is presumed to remain a patient until the patient-practitioner
relationship is terminated.
2. The consent to, initiation
of, or participation in sexual behavior or involvement with a practitioner by a
patient does not change the nature of the conduct nor negate the statutory
prohibition.
C. Sexual contact between a
practitioner and a former patient. Sexual contact between a practitioner and a
former patient after termination of the practitioner-patient relationship may
still constitute unprofessional conduct if the sexual contact is a result of
the exploitation of trust, knowledge, or influence of emotions derived from the
professional relationship.
D. Sexual contact between a
practitioner and a key third party shall constitute unprofessional conduct if
the sexual contact is a result of the exploitation of trust, knowledge or
influence derived from the professional relationship or if the contact has had
or is likely to have an adverse effect on patient care. For purposes of this
section, key third party of a patient shall mean spouse or partner, parent or
child, guardian, or legal representative of the patient.
E. Sexual contact between a
supervisor and a trainee shall constitute unprofessional conduct if the sexual
contact is a result of the exploitation of trust, knowledge or influence
derived from the professional relationship or if the contact has had or is
likely to have an adverse effect on patient care.
18VAC112-20-200. Advertising
ethics.
A. Any statement specifying
a fee, whether standard, discounted or free, for professional services that
does not include the cost of all related procedures, services and products which,
to a substantial likelihood, will be necessary for the completion of the
advertised service as it would be understood by an ordinarily prudent person
shall be deemed to be deceptive or misleading, or both. Where reasonable
disclosure of all relevant variables and considerations is made, a statement of
a range of prices for specifically described services shall not be deemed to be
deceptive or misleading.
B. Advertising a discounted
or free service, examination, or treatment and charging for any additional
service, examination, or treatment that is performed as a result of and within
72 hours of the initial office visit in response to such advertisement is
unprofessional conduct unless such professional services rendered are as a
result of a bona fide emergency. This provision may not be waived by agreement
of the patient and the practitioner.
C. Advertisements of
discounts shall disclose the full fee that has been discounted. The
practitioner shall maintain documented evidence to substantiate the discounted
fees and shall make such information available to a consumer upon request.
D. A licensee shall not use
the term "board certified" or any similar words or phrase calculated
to convey the same meaning in any advertising for his practice unless he holds
certification in a clinical specialty issued by the American Board of Physical
Therapy Specialties.
E. A licensee of the board
shall not advertise information that is false, misleading, or deceptive. For an
advertisement for a single practitioner, it shall be presumed that the
practitioner is responsible and accountable for the validity and truthfulness
of its content. For an advertisement for a practice in which there is more than
one practitioner, the name of the practitioner or practitioners responsible and
accountable for the content of the advertisement shall be documented and
maintained by the practice for at least two years.
F. Documentation, scientific
and otherwise, supporting claims made in an advertisement shall be maintained
and available for the board's review for at least two years.
VA.R. Doc. No. R07-269;
Filed August 10, 2009, 9:58 a.m.