Subchapter A. PHYSICAL THERAPISTS

§ 40.1. Definitions.

 The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

   Act—The Physical Therapy Practice Act (63 P. S. § §  1301—1313).

   Board—The State Board of Physical Therapy.

   Direct on-premise supervision—The physical presence of a physical therapist on the premises where the physical therapist assistant or the supportive personnel is providing patient-care services, so that the physical therapist is immediately available to provide supervision, direction and control.

   Physical therapist—A person licensed under the act and this chapter to provide physical therapy services without restriction in this Commonwealth.

   Supportive personnel—Persons other than physical therapist assistants who aid and assist a physical therapist but whose activities do not require the formal education or knowledge of a physical therapist or physical therapist assistant. The term does not include secretarial, administrative and other personnel who are not involved in direct patient care.

   The provisions of this §  40.1 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and section 3 of the Physical Therapy Practice Act (63 P. S. §  1303); and amended under sections 3(a), 5, 6(d.1), 8(b), 9.1, 9.2, 10 and 11(a)(6) of the Physical Therapy Practice Act (63 P. S. § §  1303(a), 1305, 1306(d.1), 1308(b), 1309.1, 1309.2, 1310 and 1311(a)(6)); and section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a).

 The license issued to those practicing physical therapy does not authorize the right to use the title ‘‘Doctor of Medicine,’’ or the right to use drugs administered internally. Except as authorized in section 9 of the act (63 P. S. §  1309), a person licensed under the act as a physical therapist may not treat human ailments by physical therapy or otherwise except upon the referral of a physician or other person authorized by law to order the same.

   The provisions of this §  40.2 amended under section 3 of the Physical Therapy Practice Act (63 P. S. §  1303); and section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a).

 The act continues past law in defining physical therapy and governing its practice in this Commonwealth, and it is not meant to limit or restrict those who are engaged in certain occupations or jobs which do not require a license, such as, but not limited to, physical education directors, health or recreation directors at health clubs or spas, athletic trainers and masseurs. The duties which may be properly undertaken in such occupation or job include the nontherapeutic administration of baths, massage, normal exercise, normal conditioning, and the like to normal subjects, that is those persons who have no specific pathology upon which said acts are being administered; first aid subjects are excluded. If, under their duties, unlicensed individuals perform acts, some of which are described in this section, that are deemed to relate directly or indirectly to the evaluation, treatment or therapeutic management of a specific pathology in the subject, the person administering the acts shall be subject to fine and penalty as provided by law.

 Admission to the practice of physical therapy in this Commonwealth will be granted by the Board as follows:

   (1)  By the issuance of a license to an applicant who meets the requirements for licensure as set forth in sections 5 and 6 of the act (63 P. S. § §  1305 and 1306).

   (2)  By the issuance of a license by endorsement to an applicant who is educated in another state or territory of the United States and who meets the licensing requirements in section 6 of the act (63 P. S. §  1306) and who holds a valid license by examination in another state or territory of the United States, providing the requirements were, at the time of receiving the license, substantially equal to the requirements as set forth in the act.

   (3)  By the issuance of a temporary license to an applicant who meets the licensing requirements as set forth in section 6 of the act.

   (4)  By the issuance of a license to an applicant educated in a jurisdiction other than a state or territory of the United States who meets the licensing requirements as set forth in sections 5 and 6(f) of the act.

   (5)  By the issuance of a license by endorsement to an applicant who is educated in a foreign country and who is authorized to practice as a physical therapist without limitations in the country where the professional education occurred and who holds a valid license by examination in another state or territory of the United States providing the requirements were, at the time of receiving the license, substantially equivalent to the requirements as set forth in the act.

   The provisions of this §  40.4 amended under section 3(a) of the Physical Therapy Practice Act (63 P. S. §  1303(a)); and section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a).

 The following fees are charged by the Board:

   The provisions of this §  40.5 issued under section 8 of the Physical Therapy Practice Act (63 P. S. §  1308); amended under section 812.1(a) of The Administrative Code of 1929 (71 P. S. §  279.3a); and sections 3, 5 and 8(b) of the Physical Therapy Practice Act (63 P. S. § §  1303, 1305 and 1308(b)).

   The provisions of this §  40.5 adopted November 4, 1988, effective November 5, 1988, 18 Pa.B. 4952; amended March 16, 1990, effective March 17, 1990, 20 Pa.B. 1504; amended May 14, 1993, effective May 15, 1993, and apply retroactively to fees for March 1993 examinations, 23 Pa.B. 2333; amended December 30, 1994, effective December 31, 1994, 24 Pa.B. 6567; amended December 22, 1995, effective December 23, 1995, apply to examination fees charged on and after September 1, 1995, 25 Pa.B. 5968; amended October 25, 1996, effective October 26, 1996, and apply to examinations administered by PES after October 26, 1996, 26 Pa.B. 5110; amended May 26, 2000, effective May 27, 2000, and apply to examinations administered after the effective date of this amendment, 30 Pa.B. 2592; amended January 26, 2001, effective January 27, 2001, 31 Pa.B. 537; amended March 29, 2002, effective March 30, 2002, 32 Pa.B. 1658; amended July 16, 2004, effective July 17, 2004, 34 Pa.B. 3700. Immediately preceding text appears at serial pages (287924) to (287925).

   This section cited in 49 Pa. Code §  40.15 (relating to examinations); and 49 Pa. Code §  40.16 (relating to licensure by endorsement).

LICENSURE

§ 40.11. License by examination; requirements for examination.

 An applicant for license by examination shall have graduated from a physical therapy program accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE) which has provided adequate instruction in basic sciences, clinical science and physical therapy theory and procedures.

   The provisions of this §  40.11 amended under section 3(a) of the Physical Therapy Practice Act (63 P. S. §  1303(a)); and section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a).

   The provisions of this §  40.11 adopted July 29, 1977, effective July 30, 1977, 7 Pa.B. 2138; amended August 27, 2004, effective August 28, 2004, 34 Pa.B. 4697. Immediately preceeding text appears at serial pages (287925) to (287926).

 (a)  Evidence, satisfactory to the Board, shall be submitted indicating that the applicant:

   (1)  Is at least 20 years of age, unless otherwise waived upon application to and review by the Board.

   (2)  Is of good moral character.

   (3)  Is not addicted to the habitual use of alcohol, narcotics or other habit forming drugs.

   (4)  Has met the professional requirements as set forth in §  40.11 (relating to license by examination; requirements for examination).

   The provisions of this §  40.12 adopted July 29, 1977, effective July 30, 1977, 7 Pa.B. 2138.

 (a)  An applicant for licensure shall pass the approved licensing examination described in section 6(b) of the act (63 P. S. §  1306(b)). The Board’s approved vendor conducts at least two written examinations each year. The examinations will be conducted in the English language in the following areas:

   (1)  Basic science.

   (2)  Clinical science.

   (3)  Physical therapy theory and procedures.

 (b)  Oral or practical examinations, or both, for licensure may be administered by the Board-approved vendor under section 6(b) of the act, in addition to the requirement of passing a written examination for licensure.

   The provisions of this §  40.13 amended under section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a); and section 8 of the Physical Therapy Practice Act (63 P. S. §  1308).

 (a)  Applicants shall successfully pass, to the satisfaction of the Board, the examination approved by the Board. In cases of failure at the first examination, the applicant shall have, after the expiration of 6 months and within 2 years from the date of the first failure, the privilege of a second examination, with the payment of an additional examination fee charged by the vendor.

 (b)  After a second or successive failure to pass the examination, an applicant desiring to take a third or successive examination shall make a new application within the meaning of section 5 of the act (63 P. S. §  1305) within 6 months from the date of the last failure. However, prior to filing a new application for examination, the Board may require evidence of additional training. If the Board determines that the applicant will be permitted to take a third or successive examination, the Board may authorize in connection with a written examination an oral or practical examination, or both, to test the knowledge and competence of the applicant.

 (c)  The granting of permission by the Board to take a third or successive examination is at all times subject to the applicant otherwise qualifying under the requirements in force at the time permission to take the examination is sought.

   The provisions of this §  40.14 amended under section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a); and sections 3(a) and 8 of the Physical Therapy Practice Act (63 P. S. § §  1303(a) and 1308).

 (a)  An application for licensure by examination may be obtained from the State Board of Physical Therapy, Post Office Box 2649, Harrisburg, Pennsylvania, 17105-2649.

 (b)  An applicant may not be admitted to examination who is unable to present, at the time of application, the required credentials of professional education from an approved institution.

   The provisions of this §  40.15 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and section 3 of the Physical Therapy Practice Act (63 P. S. §  1303); amended under sections 3(a) and 8 of the Physical Therapy Practice Act (63 P. S. § §  1303(a) and 1308); and section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a).

 (a)  An applicant for licensure by endorsement who is educated in another state or territory of the United States is required to submit the professional credentials in §  40.11 (relating to license by examination; requirements for examination), and comply with the following:

   (1)  Submit a written application on forms provided by the Board, together with evidence satisfactory to the Board that the applicant is licensed or otherwise registered as a physical therapist in another state or territory of the United States, or in the District of Columbia, if the requirements for licensure or registration in the state, territory or district were, at the date of licensure or registration, substantially equal to the requirements for licensure or registration in this Commonwealth under the act.

   (2)  A fee prescribed in §  40.5 (relating to fees) must accompany each application for licensure by endorsement.

 (b)  An applicant for licensure by endorsement who received education in a country outside of the United States is required to meet the educational requirements as set forth in §  40.17(5) and (6) (relating to foreign-educated physical therapists applying to take the licensure examination and pursue a clinical experience) and comply with the following:

   (1)  The applicant shall submit documentary evidence that the applicant is authorized to practice as a physical therapist without limitation in the country where the professional education occurred.

   (2)  The applicant shall hold a valid license by examination in another state or territory of the United States providing the requirements were, at the time of receiving the license, substantially equivalent to the requirements as set forth in the act.

   The provisions of this §  40.16 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and section 3 of the Physical Therapy Practice Act (63 P. S. §  1303); amended under sections 3(a) and 8 of the Physical Therapy Practice Act (63 P. S. § §  1303(a) and 1308); and section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a).

 To be eligible to take the examination for licensure, foreign-educated applicants for licensure shall comply with the following conditions:

   (1)  The applicant shall submit evidence, satisfactory to the Board, indicating that the applicant has met the requirements stated in §  40.12(a)(1)—(3) (relating to application for licensure).

   (2)  The applicant shall provide written documentation that the school of physical therapy is recognized by the authorizing agency or entity of the jurisdiction in which the school is situated.

   (3)  The applicant shall provide written documentation of authorization to practice as a physical therapist without limitations in the country where the professional education took place.

   (4)  The applicant shall provide documentation of legal authorization to seek employment in the United States or its territories.

   (5)  The applicant shall meet educational requirements by securing a credentials evaluation from a recognized and accredited evaluation agency approved by the Board. The credentials evaluation must demonstrate that the applicant has met the requirement of at least 120 semester credit hours of which at least 42 credit hours must be in general education subjects and 69 credit hours must be in professional education subjects. If an applicant has deficiencies in general education or professional education, the applicant can correct the deficiencies as follows:

     (i)   General education. A minimum of one semester course must be successfully completed in each of the following areas of general education unless otherwise noted:

       (A)   Humanities.

       (B)   Physical science (two courses each in chemistry and physics including laboratory sessions).

       (C)   Biological science.

       (D)   Social science.

       (E)   Behavioral science.

       (F)   Mathematics.

     (ii)   Professional education. The applicant shall complete 69 credit hours of professional education the content of which includes:

       (A)   Basic health science including:

         (I)   Human anatomy (specific to physical therapy).

         (II)   Human physiology (specific to physical therapy).

         (III)   Neuroscience.

         (IV)   Kinesiology or functional anatomy.

         (V)   Pathology.

       (B)   Medical and clinical science coursework including the following:

         (I)   Clinical medicine pertinent to physical therapy including:

           (-a-)   Neurology.

           (-b-)   Orthopedics.

           (-c-)   Pediatrics.

           (-d-)   Geriatrics.

           (-e-)   Cardiopulmonary.

           (-f-)   Pharmacology.

         (II)   Physical therapist coursework must include:

           (-a-)   Examination, evaluation and intervention pertaining to the integumentary system.

           (-b-)   Examination, evaluation and intervention pertaining to the musculoskeletal system.

           (-c-)   Examination, evaluation and intervention pertaining to the neuromuscular system.

           (-d-)   Examination, evaluation and intervention pertaining to the cardiopulmonary system.

     (iii)   Clinical education. Clinical education must include physical therapist-supervised application of physical therapy theory, examination, evaluation and intervention. The applicant shall have a minimum of two full-time clinical internships of at least 800 hours total, which are supervised by a physical therapist. The maximum number of full-time clinical education credits is 23.

     (iv)   Related professional coursework. Content is required in the following nine areas:

       (A)   Professional behaviors.

       (B)   Administration.

       (C)   Community health.

       (D)   Research and clinical decision making.

       (E)   Educational techniques.

       (F)   Medical terminology.

       (G)   Communication (related to client/patient care).

       (H)   Legal and ethical aspects of physical therapy practice.

       (I)   Psychosocial aspects in physical therapy practice.

   (6)  General educational deficiencies. The applicant may correct general educational deficiencies in the areas specified in paragraph (5)(i) by either:

       (A)   Pursuing studies in an accredited college or university. Upon completion of studies, the applicant shall submit an official transcript to the Board.

       (B)   Attaining college credit through successful completion of the following examinations offered by the College Level Examination Program (CLEP). No more than 30 credits may be obtained through CLEP.

         (I)   The CLEP General Examination may be used to satisfy the requirements in paragraph (5)(i) for credit hours if passing scores are received in the following subjects:

         (II)   The CLEP Subject Examination may be used to satisfy the requirements in paragraph (5) for credit hours if passing scores are received in the following subjects:

         (III)   The applicant is responsible for directing that CLEP report his examination scores to the Board.

   (7)  Clinical experience. The applicant shall complete, at the Board’s discretion, up to 1 year of supervised clinical experience in the United States, as approved by the Board.

     (i)   To apply for approved supervised clinical experience the applicant shall:

       (A)   Submit a notarized application signed by the sponsoring physical therapist who will supervise the applicant in the institution in which the applicant will be pursuing the clinical experience.

       (B)   Arrange for and have a personal interview with a member of the Board and have the application forms signed and approved by the Board member.

       (C)   Submit a passport-size photograph for the purpose of identification. The applicant and a sponsor shall both sign either the photograph or the paper on which the photograph is mounted.

     (ii)   The applicant may obtain the required clinical experience while pursuing studies to correct educational deficiencies in the areas specified in paragraph (5).

     (iii)   The applicant shall submit a letter from the supervising physical therapist in the institution where the supervised clinical experience was completed, certifying the applicant’s clinical competence.

   The provisions of this §  40.17 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and section 3 of the Physical Therapy Practice Act (63 P. S. §  1303); and amended under sections 3(a), 5 and 10 of the Physical Therapy Practice Act (63 P. S. § §  1303(a), 1305 and 1310); and section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a).

   The provisions of this §  40.17 adopted July 29, 1977, effective July 30, 1977, 7 Pa.B. 2138; amended October 4, 1985, effective October 5, 1985, 15 Pa.B. 3513; amended August 27, 2004, effective August 28, 2004, 34 Pa.B. 4697. Immediately preceding text appears at serial pages (287929) and (206193) to (206195).

   The provisions of this §  40.18 adopted July 29, 1977, effective July 30, 1977, 7 Pa.B. 2138; reserved August 27, 2004, effective August 28, 2004, 34 Pa.B. 4697. Immediately preceeding text appears at serial page (206195).

TEMPORARY LICENSES

§ 40.21. [Reserved].

 (a)  An applicant for temporary license under section 6(g) of the act (63 P. S. §  1306(g)) shall apply to the Board on forms provided by the Board and meet the following requirements:

   (1)  Fulfill to the satisfaction of the Board the requirements set forth under section 6(a) of the act.

   (2)  Have made application to take the examination set forth in section 6(b) of the act or have taken the examination and be awaiting the results of the examination.

   (3)  Received the temporary license from the Board, work only under the direct on premises supervision of a licensed physical therapist with at least 2 years of experience.

 (b)  A temporary license issued under 6(g) of the act must be surrendered to the Board immediately upon the failure of the first examination or 6 months after the date of issuance, whichever occurs first.

   The provisions of this §  40.22 amended under section 3(a) of the Physical Therapy Practice Act (63 P. S. §  1303(a)); and section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a).

   The provisions of this §  40.24 adopted July 29, 1977, effective July 30, 1977, 7 Pa.B. 2138; reserved August 27, 2004, effective August 28, 2004, 34 Pa.B. 4697. Immediately preceeding text appears at serial page (206197).

SUPPORTIVE PERSONNEL

§ 40.31. [Reserved].

 Supportive personnel shall identify themselves to patients as supportive personnel.

   The provisions of this §  40.31a issued under section 3(a) of the Physical Therapy Practice Act (63 P. S. §  1303(a)); and section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a).

 (a)  The physical therapist may only allow supportive personnel to perform patient-related activities which do not require the formal education or training and the skill and knowledge of a physical therapist or physical therapist assistant, and only while the supportive personnel are under the direct on-premise supervision of a physical therapist.

 (b)  The physical therapist may not permit supportive personnel to provide physical therapy services. The physical therapist may permit supportive personnel to perform the following:

   (1)  Patient assistance in preparation for treatment, as necessary during treatment and at the conclusion of treatment.

   (2)  Application of superficial heat or cold as an adjunct to the treatment program.

   (3)  Assembly, disassembly and maintenance of equipment and accessories.

   (4)  Transportation of patients.

   (5)  Assistance to patients with nontreatment aspects of activities and attending the personal needs of patients.

   (6)  Recording information through the use of flow sheets and checklists which identify activities performed by the patient.

 (c)  The physical therapist may not permit supportive personnel to interpret referrals, perform evaluation procedures, conduct tests, initiate or adjust treatment programs, assume responsibility for patient care or document physical therapy treatment.

   The provisions of this §  40.32 issued under sections 3(a), 6(d.1), 8(b), 9.1, 9.2 and 11(a)(6) of the Physical Therapy Practice Act (63 P. S. § §  1301(a), 1306(d.1), 1308(b), 1309.1, 1309.2 and 1311(a)(6)); amended under section 3(a) of the Physical Therapy Practice Act (63 P. S. §  1303(a)); and section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a).

   The provisions of this §  40.32 adopted July 24, 1992, effective July 25, 1992, 22 Pa.B. 3872; amended August 27, 2004, effective August 28, 2004, 34 Pa.B. 4697. Immediately preceeding text appears at serial pages (206197) to (206198).

   This section cited in 49 Pa. Code §  40.52 (relating to unprofessional conduct; physical therapists).

RULES AND REGULATIONS OF THE BOARD

§ 40.41. Hearings relating to revocation or suspension of license.

 Under 1 Pa. Code §  31.1 (relating to scope of part), 1 Pa. Code Part II (relating to administrative practice and procedure) is applicable to the activities of and proceedings before the Board.

   The provisions of this §  40.42 adopted July 29, 1977, effective July 30, 1977, 7 Pa.B. 2138; reserved October 4, 1985, effective October 5, 1985, 15 Pa.B. 3515. Immediately preceding text appears at serial page (88283).

SCOPE OF PRACTICE

§ 40.51. Administration of electroneuromyography (EMG) and nerve conduction velocity (NCV) tests.

 (a)  EMG and NCV—studies and evaluations—shall be conducted only upon the referral of a physician, under section 9 of the act (63 P. S. §  1309).

 (b)  A licensed physical therapist may not diagnose from the results of the tests, but may prepare a statement of his impression of the results of the test to be forwarded to the referring physician for his review and diagnosis.

 A physical therapist may perform transdermal administration of drugs through the use of modalities such as ultrasound and electrical stimulation. If a prescriptive medication is used, the medication must be prescribed by the referring physician and dispensed in the name of the patient by the referring physician or pharmacist. Between treatment sessions, drugs must be properly stored in a manner consistent with pharmaceutical practice. After the patient is discharged, the remaining drugs must be disposed of by the physical therapist or returned to the patient.

   The provisions of this §  40.51a issued under section 3(a) of the Physical Therapy Practice Act (63 P. S. §  1303(a)); and section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a).

 A physical therapist who engages in unprofessional conduct is subject to disciplinary action under section 11(a)(6) of the act (63 P. S. §  1311(a)(6). Unprofessional conduct includes the following:

   (1)  Harassing, abusing or intimidating a patient.

   (2)  Revealing information obtained as a result of the therapist-patient relationship to a third party who is not involved in the patient’s care, without the prior written consent of the patient, except as authorized or required by statute.

   (3)  Failing to exercise appropriate supervision over a person who is authorized to render services only under the supervision of the physical therapist.

   (4)  Accepting a patient for treatment or continuing treatment if benefit cannot reasonably be expected to accrue to the patient, or misleading a patient as to the benefits to be derived from physical therapy.

   (5)  Unconditionally guaranteeing the results of physical therapy treatment.

   (6)  Practicing physical therapy while the ability to practice is impaired by alcohol, drugs or a physical or mental disability.

   (7)  Charging a patient or a third-party payor for a physical therapy service which is not performed.

   (8)  Receiving a fee for referring a patient to a third person.

   (9)  Advertising physical therapy services in a false, misleading or deceptive manner.

   (10)  Assigning or delegating to physical therapist assistants or supportive personnel activities prohibited from assignment or delegation under § §  40.32, 40.53 and 40.171 (relating to functions of supportive personnel; nondelegable activities; accountability; and functions of physical therapist assistants).

   (11)  Violating a provision of the act or this chapter which establishes a standard of conduct.

   (12)  Failure to maintain adequate patient records. Adequate patient records include at a minimum sufficient information to identify the patient, a summary of the findings of the examination, an evaluation, a diagnosis, the plan of care including desired outcomes, and the treatment record.

   The provisions of this §  40.52 issued under sections 3, 5 and 10 of the Physical Therapy Practice Act (63 P. S. § §  1303, 1305 and 1310); amended under sections 3(a), 6(d.1), 8(b), 9.1, 9.2 and 11(a)(6) of the Physical Therapy Practice Act (63 P. S. § §  1303(a), 1306(d.1), 1308(b), 1309.1, 1309.2 and 1311(a)(6)); and section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a).

   The provisions of this §  40.52 adopted October 4, 1985, effective October 5, 1985, 15 Pa.B. 3513; amended July 24, 1992, effective July 25, 1992, 22 Pa.B. 3872; amended August 27, 2004, effective August 28, 2004, 34 Pa.B. 4697. Immediately preceding text appears at serial pages (290329) to (290330).

   Unprofessional Conduct

   Act of removing 90 patient files from hospital’s premises for 1 year and 4 months due to physical therapist’s inability to complete documentation of patient files in a timely manner, related to the level of care provided to a patient and not to an administrative practice, was unprofessional conduct that subjected hospital to liability and jeopardized the level of care provided to a patient; therefore, the State Board of Physical Therapy properly found that physical therapist was subject to disciplinary action. Korch v. State Board of Physical Therapy, 900 A.2d 941, 947 (Pa. Cmwlth. 2006).

   Physical therapist’s removal of 90 patient files from hospital employer for 1 year and 4 months due to his inability to complete the necessary documentation in a timely manner and only returned the files after legal counsel demanded they be returned, supported State Board of Physical Therapy’s imposition of formal reprimand and $1,000 civil penalty. Korch v. State Board of Physical Therapy, 900 A.2d 941, 943, 947 (Pa. Cmwlth. 2006).

 (a)  A physical therapist may delegate to a physical therapist assistant or supportive personnel that which he is educated to perform subject to the limitations in this section.

 (b)  A physical therapist may not assign or delegate to physical therapist assistants or supportive personnel functions which require the formal education or training and the skill and knowledge of a licensed physical therapist, including the following functions:

   (1)  Interpretation of referrals.

   (2)  Initial evaluation or reevaluation.

   (3)  Determination or modification of a patient plan of care.

   (4)  Final discharge assessment/evaluation or establishment of discharge plan.

   (5)  Therapeutic techniques and procedures beyond the skill and knowledge of the physical therapist assistant.

   (6)  Duties, the delegation of which is inconsistent with minimum standards of acceptable physical therapy practice embraced by the physical therapy community in this Commonwealth.

   (7)  Mobilization. Mobilization is defined as a group of techniques comprising a continuum of skilled passive movements to the joints or related soft tissues, or both, throughout the normal physiological range of motion that are applied at varying speeds and amplitudes, without limitation.

   (8)  The performance of consultations.

 (c)  A physical therapist may not assign or delegate to supportive personnel activities which require the formal education or training and skill and knowledge of a licensed physical therapist or registered physical therapist assistant.

 (d)  When patient-care services are provided by the physical therapist assistant, the physical therapist shall document reevaluations and adjustments to a patient plan of care and goals at least every 30 calendar days or when there is a significant change in patient status warranting an earlier patient evaluation.

 (e)  A physical therapist may not assign or delegate to a physical therapist assistant or supportive personnel screenings to determine the need for the following:

   (1)  Primary, secondary or tertiary services.

   (2)  Further examination or intervention.

   (3)  Consultation by a physical therapist.

   (4)  Referral to another health care practitioner.

 (f)  For purposes of this section, screening is defined as determining the need for further examination or intervention, or both, by a physical therapist or for referral to another health professional.

   The provisions of this §  40.53 amended under sections 3(a), 6(d.1), 8(b), 9.1, 9.2 and 11(a)(6) of the Physical Therapy Practice Act (63 P. S. § §  1303(a), 1306(d.1), 1308(b), 1309.1, 1309.2 and 1311(a)(6)); and section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a).

   The provisions of this §  40.53 adopted May 4, 1990, effective May 5, 1990, 20 Pa.B. 2437; amended July 24, 1992, effective July 25, 1992, 22 Pa.B. 3872; amended August 27, 2004, effective August 28, 2004, 34 Pa.B. 4697. Immediately preceding text appears at serial page (290330).

   Insurance Coverage

   The Pennsylvania Motor Vehicle Financial Responsibility Law obligated the insuror to pay for physical therapy treatments provided by a trained but unlicensed technician operating under the general supervision of a physician, notwithstanding the ‘nondelegable’ nature of the duties of a physical therapist pursuant to this section. Nelson v. Nationwide Mutual Insurance Co., 35 Phila. 88, (C. P. 1998).

 (a)  Definitions. The following words and terms, when used in this section, have the following meanings, unless the context clearly indicates otherwise:

   (1)  Appliances or devices—Gas, oxygen, therapy equipment, therapeutic equipment, instruments, syringes and their component parts or accessories, hearing aids, eyeglasses, contact lenses, prosthetic devices, orthotics, crutches and cervical collars.

   (2)  Disclose to the patient—The physical therapist makes known to the patient at the time a referral is made that the physical therapist has a financial or ownership interest in the facility or entity to which the patient is referred. The physical therapist shall also inform the patient of the patient’s freedom to choose an alternate provider.

   (3)  Facility or entity—Another practitioner of the healing arts, licensed health care practitioner, partnership, association, group practice, business corporation and professional corporation not on the premises of the physical therapist.

   (4)  Financial interest of the physical therapist or ownership by the physical therapist in the facility or entity—A financial or ownership interest to any extent or degree including interest held by the physical therapist, the therapist’s spouse or minor children. The term does not include employment by a hospital if the remuneration paid to the physical therapist is not contingent upon the therapist’s referral of patients to hospital-related services.

   (5)  Health-related services—Radiologic services, physical therapy, occupational therapy, counseling, laboratory services and nursing home care.

   (6)  Pharmaceutical—A drug or pharmacy.

   (7)  Practitioner of the healing arts—A physical therapist.

   (8)  Referral—The act of prescribing, ordering, directing, redirecting or recommending to a patient a specific facility or entity which provides a health-related service, test, pharmaceutical, appliance or device, by means of prescription, recomended course of treatment, or direction concerning diagnostic or therapeutic treatment of services.

   (9)  Test—Laboratory work, radiologic tests, nuclear medicine scanning and other laboratory services.

 (b)  Use of patient disclosure forms.

   (1)  It is the physical therapist’s responsibility to disclose to the patient a financial or ownership interest when making a referral covered by the act of May 26, 1988 (P. L. 403, No. 66) (35 P. S. § §  449.21—449.23). The Board believes that meaningful disclosure shall be given to each patient at the time a referral is made. The disclosure may be made orally or in writing. In either event, it is recommended that the disclosure be memorialized, dated and signed at the time of referral by the physical therapist and the patient, and that the physical therapist maintain written evidence of the disclosure. If the physical therapist delegates the disclosure to another person in the therapist’s office, the disclosure shall be memorialized, dated and signed by the person making the disclosure and the patient.

   (2)  The memorialization of the disclosure shall be substantially in the following form:

  I ACKNOWLEDGE THAT I HAVE BEEN ADVISED BY MY PHYSICAL THERAPIST THAT HE HAS A FINANCIAL OR OWNERSHIP INTEREST IN THE FACILITY OR ENTITY TO WHICH HE HAS REFERRED ME, AND THAT HE HAS ADVISED ME THAT I AM FREE TO CHOOSE ANOTHER FACILITY OR ENTITY TO PROVIDE THE SERVICE, DRUG, DEVICE OR EQUIPMENT.

   (3)  Written evidence shall constitute presumptive evidence that the physical therapist made the required disclosure in an enforcement proceeding before the Board. The disclosure to the patient is not the act of the patient signing the form, but is the act of the physical therapist disclosing to the patient the therapist’s financial or ownership interest and advising the patient of the patient’s freedom of choice.

 (c)  Guidelines for disclosure. If the patient is a minor, unconscious, of unsound mind, or otherwise incompetent to understand freedom of choice in the selection of a facility or entity, disclosure shall be made to the guardian, spouse or closest adult next of kin. A physical therapist may not disclose his interest unless the patient is competent to understand his freedom of choice. A physical therapist will not be disciplined for failure to disclose if an emergency prevents consulting the patient or the patient’s next of kin.

 (d)  Posting notice of disclosure requirement. It is recommended that compliance with the disclosure requirement include the prominent posting of a printed notice, at least 8 1/2" x 11" in the physical therapist’s waiting room in all office locations, substantially in the following form:

  TREATMENT IN THIS OFFICE MAY INCLUDE A RECOMMENDATION FOR FURTHER DIAGNOSTIC TESTING, FOR VARIOUS FORMS OF THERAPY OR TREATMENT, OR FOR DRUGS OR DEVICES. PENNSYLVANIA LAW REQUIRES YOUR PHYSICAL THERAPIST TO DISCLOSE TO YOU ANY FINANCIAL INTEREST HE HAS IN TREATMENT FACILITIES, TESTING LABORATORIES, MEDICAL EQUIPMENT SUPPLIES, PHARMACEUTICAL COMPANIES AND PHARMACIES TO WHICH HE REFERS YOU. HE MUST ALSO ADVISE YOU THAT YOU ARE FREE TO CHOOSE ANOTHER FACILITY OR ENTITY TO PROVIDE THE SERVICE, DRUG, DEVICE OR EQUIPMENT. (ACT 66-1988)

 Physical therapists shall identify themselves to patients as physical therapists.

   The provisions of this §  40.55 issued under section 3(a) of the Physical Therapy Practice Act (63 P. S. §  1303(a)); and section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a).

   The provisions of this §  40.55 adopted August 27, 2004, effective August 28, 2004, 34 Pa.B. 4697.

PRACTICE WITHOUT PHYSICIAN REFERRAL

§ 40.61. Certificate of authorization to practice physical therapy without a referral.

 (a)  An applicant for certification of authorization to practice physical therapy without the referral of a licensed physician shall submit evidence satisfactory to the Board, on forms supplied by the Board, that the applicant has met the following requirements:

   (1)  Holds a current license to practice physical therapy in this Commonwealth.

   (2)  Has done one of the following:

     (i)   Passed the National Physical Therapy Examination (NPTE) after January 1, 1990.

     (ii)   Passed the NPTE prior to January 1, 1990 and successfully completed, within 2 years prior to application, a Board approved course consisting of at least 10 hours on the appropriate evaluative and screening procedures to determine the need for further examination or consultation by a physician, dentist or podiatrist prior to initiating treatment without a referral. The Board will maintain a list of currently approved courses.

   (3)  Has done one of the following:

     (i)   Practiced physical therapy in the delivery of patient care on a continuous basis for at least 2 years immediately preceding the application for certificate of authorization.

     (ii)   Been licensed by endorsement and practiced physical therapy in the delivery of patient care as a licensed physical therapist in the other state on a continuous basis for at least 2 years immediately preceding the application for certificate of authorization.

     (iii)   Provided proof of meeting these practice requirements through any combination of subparagraphs (i) and (ii).

     (iv)   For purposes of this section, ‘‘practice of physical therapy on a continuous basis’’ is defined as a minimum of 200 hours each year in the delivery of direct patient care.

   (4)  Has obtained professional liability insurance under the requirements of §  40.62 (relating to liability insurance).

 (b)  A certificateholder shall display the certificate of authorization in a manner conspicuous to the public.

 (c)  A certificateholder may not delegate the care of a patient being treated without a referral to a physical therapist who is not a certificateholder.

 (d)  A certificateholder shall refer patients to a licensed physician or other appropriate health care practitioner in the following cases:

   (1)  Cases where symptoms are present for which physical therapy is a contraindication.

   (2)  Cases for which treatment is outside the scope of practice of physical therapy.

   (3)  Cases for which treatment is beyond the education, expertise or experience of the physical therapist.

 (e)  A certificateholder may treat a person without a referral as provided in this chapter for up to 30 calendar days from the date of the first treatment. A physical therapist may not treat a person beyond 30 days from the date of the first treatment unless the person has obtained a referral from a licensed physician, dentist or podiatrist. The date of the first treatment for purposes of this subsection is the date the person is treated by any physical therapist treating without a referral.

 (f)  A certificateholder may not treat a condition in any person which is a nonneurologic, nonmuscular or nonskeletal condition or treat a person who has an acute cardiac or acute pulmonary condition unless the certificateholder has consulted with the person’s licensed physician, dentist or podiatrist regarding the person’s condition and the physical therapy treatment plan or has referred the person to a licensed physician, dentist or podiatrist for diagnosis and referral.

   The provisions of this §  40.61 issued under section 3 of the Physical Therapy Practice Act (63 P. S. §  1303); and section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a).

 (a)  Beginning January 1, 2005, or upon applying for a certificate of authorization, whichever occurs earlier, a licensee who applies for and obtains a certificate of authorization shall obtain and maintain professional liability insurance coverage in the minimum amount required to be maintained by physicians under section 711 of the Medical Care Availability and Reduction of Error (MCARE) Act (40 P. S. §  1303.711).

 (b)  A certificateholder shall notify the Board within 30 days of the holder’s lapse in coverage of the required insurance.

 (c)  The certificate of authorization will automatically be suspended upon failure to be covered by the required insurance and will not be restored until submission to the Board of satisfactory evidence that the licensee has the required professional liability insurance.

 (d)  Satisfactory evidence of insurance coverage is any one of the following:

   (1)  A self-insurance plan that meets the standards and procedures established by the Insurance Department in 31 Pa. Code Chapter 243 (relating to medical malpractice and health-related self-insurance plans).

   (2)  Personally purchased professional liability insurance.

   (3)  Professional liability insurance, coverage provided by the licensee’s employer.

   (4)  A similar type of coverage.

   The provisions of this §  40.62 issued under section 3 of the Physical Therapy Practice Act (63 P. S. §  1303); and section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a).

   The provisions of this §  40.62 adopted July 16, 2004, effective July 17, 2004, 34 Pa.B. 3700.

 (a)  Definitions. The following words and terms, when used in this section, have the following meanings, unless the context clearly indicates otherwise:

   Certificateholder—A licensed physical therapist who holds a certificate of authorization to practice physical therapy without a referral.

   Contact hour—A unit of measure equaling 60 minutes of participation in an approved continuing education course or program.

 (b)  Continuing education requirement for renewal of certificate of authorization. Beginning after the first renewal of the certificate of authorization, as a condition of certificate renewal, a physical therapist shall have completed during the preceding biennium a minimum of 20 contact hours of physical therapy continuing education related to keeping the certificateholder apprised of advancements and new developments in the practice of the physical therapy profession. At least 10 of the 20 contact hours shall be in evaluative procedures to treat a person without a referral.

 (c)  Reports to the Board. A certificateholder shall certify compliance with the continuing education hours requirement at the time of biennial renewal of the certificate. A certificateholder shall retain for at least 4 years, certificates, transcripts or other documentation showing completion of the prescribed number of hours. These records are subject to audit by the Board.

 (d)  Approved sponsors; acceptable courses and programs.

   (1)  Courses and programs provided by Board-approved sponsors will be accepted as satisfying the continuing education requirement. It is the responsibility of the certificateholder to ascertain the approval status of the sponsor before undertaking a continuing education activity.

   (2)  Irrespective of the sponsor, the Board reserves the right to reject a continuing education course or program submitted by a certificateholder if it is outside the scope of practice of physical therapy. The Board will not accept courses or programs which are unrelated to the actual practice of physical therapy—for example, instruction in office management or practice building. A certificate holder will be notified of a rejected course or program in writing, along with the reason for the rejection.

   (3)  Sponsors of physical therapy continuing education seeking Board approval shall submit an application on forms provided by the Board and pay the required fee. The applicant will be notified of approval or disapproval in writing. Notifications of disapproval will set forth reasons. The Board will not approve a sponsor unless it:

     (i)   Offers courses or programs, or both, with specific learning objectives geared to improve the professional competence of the participant.

     (ii)   Verifies attendance of the course.

     (iii)   Provides each attendee with a certificate which includes participant’s name, date, place, course title, presenter and number of contact hours.

   (4)  The Board may withdraw approval of a sponsor for cause. The sponsor will be notified in writing of the reasons for withdrawal of approval.

 (e)  Distance education. A certificateholder may accrue all required hours in distance education courses offered by approved sponsors of continuing education as long as the course sponsor evaluates and assesses the extent of learning that has taken place.

 (f)  Reinstatement of certificate. Reinstatement of certificate shall be subject to the following conditions:

   (1)  A person whose certificate has lapsed or been inactive shall show compliance with the continuing education requirement during the biennium immediately preceding the request for reinstatement.

   (2)  A person whose certificate has been suspended or restricted shall show compliance with the continuing education requirement during the entire period of suspension or restriction.

 (g)  Waivers; exemptions for continuing education. The Board may, in individual cases involving physical disability or illness, or undue hardship, grant a waiver of the continuing education requirements or grant an extension of time to complete the requirements. No waiver or extension of time will be granted unless a written request is submitted by the licensee; or in cases of physical disability or illness, by a physician licensed in this state or another state or territory of the United States or the District of Columbia and whose license is in good standing, or both. All necessary documentation must be received by the Board no later than 90 days preceding the biennial renewal. If the physical disability or illness or undue hardship for which the waiver has been granted continues beyond the period of the waiver, the licensee shall reapply for an extension of the waiver. The Board may, as a condition of any waiver granted, require the applicant to make up all or part of the continuing education waived.

   The provisions of this §  40.63 issued under section 3 of the Physical Therapy Practice Act (63 P. S. §  1303); and section 812.1 of The Administrative Code of 1929 (71 P. S. 279.3a).

   The provisions of this §  40.63 adopted July 16, 2004, effective July 17, 2004, 34 Pa.B. 3700.