Chapter 4734-8 | Chiropractic Physicians

Rule 4734-8-01 | Dismissing a patientfrom a chiropractic practice.

• Effective: December 25, 2025
• Promulgated Under: 119.03

(A) A doctor-patient relationship is established when a licensee provides professional services to a person. Except as provided in paragraph (B) of this rule, every licensee must comply with the following requirements in order to dismiss a patient from care or from the chiropractic practice:

(1) Send notice to the patient that includes all of the following:

(a) A statement that the doctor-patient relationship is terminated;

(b) Except when the patient, or patient's representative, has displayed disruptive or threatening behavior toward the licensee, office staff, or other patients, a statement that the licensee will provide emergency treatment for up to thirty days from the date the letter was mailed to allow the patient an opportunity to secure care from another licensee;

(c) An offer to transfer records to a new provider upon receipt of a signed authorization.

(2) Notice must be sent in one of the following ways:

(a) A letter sent via certified mail, return receipt requested, to the last address for the patient on record, with a copy of the letter, the certified mail receipt, and the mail delivery receipt maintained in the patient record;

(b) An electronic message sent via a HIPPA compliant electronic medical record system or HIPPA compliant electronic health record system that provides a means of electronic communication to the patient and is capable of sending the patient a notification that a message is in the patient's portal and can confirm the message was viewed by the patient.

(c) If a notice sent via an electronic message as authorized in paragraph (A)(2)(b) of this rule is not viewed within ten days of having been sent, a letter sent in accordance with paragraph (A)(2)(a) of this rule.

(B) Retention of patient records must be held in accordance with rule 4734-8-04 of the Administrative Code.

(C) The requirements of paragraph (A) of this rule do not apply to the following:

(1) The licensee rendered professional services to the person on an episodic basis or in an emergency setting and the licensee should not reasonably expect that related professional services will be rendered to the patient in the future;

(2) The licensee formally transferred the patient's care to another licensee who is not in the same practice group;

(3) The licensee is leaving, selling, closing a practice, retiring from practice, or whose employment with the health care entity has ended;

(4) The patient terminated the relationship, either verbally or in writing, or has transferred care to another licensee. The licensee must maintain documentation in the patient record of the patient's action terminating the relationship.

Last updated December 25, 2025 at 12:16 AM

Supplemental Information

Authorized By: 4734.10
Amplifies: 4734.31
Five Year Review Date: 12/25/2030
Prior Effective Dates: 8/1/2019

Rule 4734-8-02 | Unlicensed supportive personnel.

• Effective: December 25, 2025
• Promulgated Under: 119.03

(A) Unlicensed supportive personnel are individuals who are properly qualified by education, training, and/or experience to perform designated tasks and duties related to patient care delivery in the practice of chiropractic. These tasks and duties do not include any activity that would require performance, clinical interpretation and/or treatment by a licensed professional.

(B) A licensed chiropractic physician must properly supervise all unlicensed supportive personnel to whom responsibilities are delegated. Properly supervise within the meaning of this rule is defined as on-site initial and ongoing direction, procedural guidance, and evaluation by an Ohio licensed chiropractic physician.

(C) It is the licensee's responsibility to ensure that unlicensed supportive personnel are competent and properly qualified by education, training, and/or experience to perform their assigned tasks and duties.

(D) The following professional tasks and duties can only be conducted when an Ohio licensed chiropractic physician is on site and delegated by the order of the licensee:

(1) Taking measurements for height, weight, blood pressure, respiration, pulse, and temperature;

(2) Recording observable signs and symptoms;

(3) Collecting bodily fluids for diagnostic purposes, not including blood draws or other invasive measures;

(4) Applying heat and cold therapy;

(5) Applying mechanical traction and/or computerized decompression;

(6) Applying electrical stimulation;

(7) Applying vasopneumatic devices;

(8) Applying diathermy;

(9) Applying therapeutic ultrasound;

(10) Instruction and supervision of therapeutic exercises;

(11) Instruction and supervision of therapeutic procedures and activities, not including manual therapy or massage therapy techniques;

(12) Instruction and supervision of neuromuscular reeducation;

(13) Low level laser therapy up to and including class IV lasers;

(14) Assist patients to safely perform activities related to the development of strength, flexibility and endurance;

(15) Applying shock wave therapy;

(16) Applying radial pulse therapy;

(17) Applying percussion or vibration therapy;

(18) Other services or procedures as deemed appropriate by the board.

Last updated December 25, 2025 at 12:16 AM

Supplemental Information

Authorized By: 4734.10
Amplifies: 4734.31
Five Year Review Date: 12/25/2030
Prior Effective Dates: 6/1/2013

Rule 4734-8-03 | Quality intervention program.

• Effective: December 25, 2025
• Promulgated Under: 119.03

(A) The board may offer an educational and assessment program to improve the practice and communication skills of a licensee, pursuant to an investigation.

(B) Providers of educational and assessment services must be qualified to provide specific education and assessment related to the practice of chiropractic. The board, in consultation with at least one case reviewer, must identify the specific education and/or assessment a licensee must complete. Case reviewers must be chiropractic physicians. Cases pertaining to acupuncture must include at least one reviewer licensed to practice acupuncture.

(C) The Board must specify the time frame during which the licensee must complete any education and/or assessment. Providers of educational and assessment must submit regular progress reports, as determined by the board, of each individual undertaking a recommended individual education program.

(D) Upon successful completion of an individual education program the board may require further monitoring of the individual or other action the board determines to be appropriate.

(E) The licensee is responsible for all expenses related to education and/or assessment.

Last updated December 25, 2025 at 12:16 AM

Supplemental Information

Authorized By: 4734.10
Amplifies: 4734.42
Five Year Review Date: 12/25/2030
Prior Effective Dates: 5/2/2003, 8/1/2007

Rule 4734-8-04 | Documentation and record keeping.

• Effective: December 25, 2025
• Promulgated Under: 119.03

(A) Every licensee must maintain proper, accurate, and legible records documenting each patient's care. If non-standard codes or abbreviations are used, a key for interpretation must be included in the file. All documentation must be in the English language.

(B) Each patient's health care record shall include all services rendered including but not limited to:

(1) Date(s) of treatment;

(2) Examinations;

(3) X-ray reports;

(4) Referrals;

(5) Diagnostic studies performed and/or ordered accompanied by a report of the results of each procedure performed or ordered;

(6) Diagnosis or clinical impression and clinical treatment plan provided to the patient.

(C) Health care records, including x-ray films must be maintained on site for current patients and may be stored off-site for former patients.

(D) Health care records must be maintained in a safe, confidential, and secure location.

(E) Health care records must be destroyed in a confidential manner, such as shredding or burning.

(F) Health care records must be retained for five years from the last date of clinical encounter, termination of care, or dismissal from care.

(G) Health care records pertaining to minors must be maintained for two years beyond the minor's eighteenth birthday, or five years from the last date of clinical encounter, whichever is longer.

(H) Health care records containing information pertinent to contemplated or ongoing legal proceedings which the licensee has knowledge or notice of must be kept for two years beyond the conclusion of the legal proceedings, or five years from the last date of clinical encounter, whichever is longer.

(I) Health care records must be released pursuant to sections 3701.74 to 3701.742 of the Revised Code.

Last updated December 25, 2025 at 12:16 AM

Supplemental Information

Authorized By: 4734.10
Amplifies: 4734.31
Five Year Review Date: 12/25/2030
Prior Effective Dates: 4/5/2009

Rule 4734-8-05 | Examination and prescription protocols.

• Effective: December 25, 2025
• Promulgated Under: 119.03

(A) Every licensee must conduct an appropriate evaluation of each patient prior to initiating treatment. Such evaluation must include :

(1) History;

(2) Examination and findings;

(3) Diagnosis(es);

(B) The history, examination, findings, and diagnosis(es) must be documented in the patient's paper or electronic file or in another readily accessible medium. Further evaluation and management must be conducted as needed, based on each patient's condition in accordance with prevailing standards of care.

(C) Once a licensee prescribes care for the management of any condition, a treatment planmust be documented to include the frequency, duration, and procedures recommended for management of the diagnosed condition(s).

Last updated December 25, 2025 at 12:16 AM

Supplemental Information

Authorized By: 4734.10
Amplifies: 4734.31
Five Year Review Date: 12/25/2030
Prior Effective Dates: 5/2/2003, 8/1/2007, 6/1/2013

Rule 4734-8-06 | Board consideration of sanctions.

• Effective: December 25, 2025
• Promulgated Under: 119.03

(A) Each disciplinary case involves unique facts and circumstances. In striving for fair disciplinary standards, consideration will be given to the specific professional misconduct and to the existence of aggravating or mitigating factors. In determining the appropriate sanction, the board must consider all relevant factors; to include precedent established by the board and the following:

(1) Aggravating factors:

(a) Disciplinary action(s) or admonishments taken by any regulatory agency, including those in Ohio;

(b) Failure to implement remedial measures to correct conduct resulting from any discipline or admonishment from any regulatory agency, including those in Ohio;

(c) Dishonest or selfish motive;

(d) A pattern of misconduct and the cumulative effect of the conduct;

(e) Multiple offenses;

(f) Lack of cooperation in the disciplinary process;

(g) Solicitation or submission of false evidence, false statements, or other obstructive or deceptive conduct during the disciplinary process;

(h) Refusal to acknowledge wrongful nature of conduct;

(i) Vulnerability of and resulting harm to any victims of the misconduct;

(j) Negative public perception of the chiropractic profession;

(k) Economic harm to any individual or entity and the severity of such harm;

(l) Failure to make restitution or other appropriate amends

(m) Any other factors the board believes to be aggravating.

(2) Mitigating factors:

(a) Absence of a prior disciplinary record or admonishments, by any regulatory agency, including those in Ohio;

(b) Absence of a dishonest or selfish motive;

(c) Timely good faith effort to make restitution or to rectify consequences of misconduct;

(d) Self-reporting of any violation(s) and full disclosure to the board and/or cooperative attitude toward proceedings;

(e) Character, reputation and positive social contributions of the chiropractic physician;

(f) Imposition of other penalties, sanctions or liability;

(g) Evidence of rehabilitation;

(h) Chemical dependency and/or mental illness, where there has been:

(i) A diagnosis of a chemical dependency or mental illness by a qualified health care professional or alcohol/substance abuse counselor;

(ii) A determination that the chemical dependency and/or mental illness contributed to cause the misconduct;

(iii) A certification of successful completion of an approved treatment program or course of treatment; and

(iv) A prognosis from a qualified health care professional or alcohol/substance abuse counselor that the chiropractic physician will be able to return to safe, competent, and ethical professional practice under specified conditions, restrictions or limitations.

(i) Any other factors the board believes to be mitigating.

(3) Compliance programs. Operation or participation in a bona fide compliance program may be considered by the board as a mitigating factor. Bona fide compliance programs shall contain the following elements:

(a) Auditing and monitoring the practice for deficiencies and violations;

(b) Written compliance standards and procedures for the practice;

(c) A designated compliance officer to monitor compliance and practice standards;

(d) Employee training and education;

(e) Appropriate response to detected violations, including self reporting and correction action plans;

(f) Developing open lines of communication;

(g) Enforcing disciplinary standards through guidelines;

(B) Alternative sanctions. The board may use the factors listed in this rule in making a determination to issue an alternative sanction in lieu of initiating formal charges through the process of Chapter 119. of the Revised Code.

Last updated December 25, 2025 at 12:16 AM

Supplemental Information

Authorized By: 4734.10
Amplifies: 4734.31, 4734.36, 4734.37, 4734.38, 4734.39, 4734.50
Five Year Review Date: 12/25/2030
Prior Effective Dates: 5/2/2003, 1/1/2019

Rule 4734-8-07 | Notice of leaving, selling or retiring from practice.

• Effective: December 25, 2025
• Promulgated Under: 119.03

(A) Except as provided for in paragraph (F) of this rule, a licensee who is an independent contractor or who has an ownership interest in a chiropractic practice shall provide notice when leaving, selling, closing the practice, or retiring from practice . Notification shall be sent to all patients who received services from the licensee within the six months immediately preceding the licensee's last date for seeing patients and shall be sent no later than thirty days prior to the last date the licensee will see patients.

(B) Notification may be provided in one of the following ways:

(1) A letter sent via regular mail to the last known address on record for the patient with the date of mailing of the letter documented;

(2) An electronic message sent via a HIPPA compliant electronic medical record system or HIPPA compliant electronic health record system that provides a means of electronic communication to the patient and is capable of sending the patient a notification that a message is in the patient's portal.

(C) Notification must include the following:

(1) The effective date the licensee will cease to provide services;

(2) Offer to transfer records to a new provider with a signed authorization;

(3) Contact information that enables the patient to obtain a copy of their records.

(D) Licensees unable to comply with this rule within the required thirty days due to acute illness or unforeseen emergency must comply with this rule no later than thirty days after it is determined that the licensee is leaving, selling, closing the practice, or retiring from practice.

(E) Licensees employed by non-Ohio licensed chiropractic physicians must comply with the notice required by paragraph (A) of this rule.

(F) If a licensee is the employee of another Ohio licensee, the patient records belong to the employer and the employee licensee is not required to comply with this rule. It is the Ohio licensee employer's responsibility to maintain continuity of care, or to comply with this rule if patient care will be terminated upon a licensee employee's leaving employment or retiring.

(G) In the event a licensee dies and there is no other licensee in the practice, the deceased licensee's executor, guardian, administrator, conservator, next of kin, or other legal representative shall endeavor to comply with the notice required by paragraph (A) of this rule.

(H) Retention of patient records must be held in accordance with rule 4734-8-04 of the Administrative Code.

Last updated December 25, 2025 at 12:16 AM

Supplemental Information

Authorized By: 4734.10
Amplifies: 4734.31
Five Year Review Date: 12/25/2030
Prior Effective Dates: 11/15/2007

Rule 4734-8-08 | Universal precautions.

• Effective: January 1, 2019
• Promulgated Under: 119.03

(A) Licensees who perform or participate in invasive procedures shall be familiar with, observe and adhere to the acceptable and prevailing standards for universal blood and body fluid precautions to minimize the risk of being exposed to or exposing others to the hepatitis B virus (HBV), the hepatitis C virus (HCV), and the human immunodeficiency virus (HIV).

(B) When performing or participating in invasive procedures licensees shall include at least the following:

(1) Appropriate use of hand washing;

(2) Effective disinfection and sterilization of equipment;

(3) Safe handling and disposal of needles and other sharp instruments; and

(4) Appropriate barrier techniques including wearing and disposal of gloves and other protective garments and devices.

(C) A licensee who performs any procedure that requires the use of needles shall utilize aseptic techniques and only sterile, disposable needles.

(D) Infectious waste such as laboratory, pathological, blood and sharps waste shall be disposed of according to requirements established by federal, local, and state environmental regulatory agencies.

Last updated December 9, 2025 at 3:33 PM

Supplemental Information

Authorized By: 4734.10
Amplifies: 4734.28, 4734.15
Five Year Review Date: 1/1/2024
Prior Effective Dates: 6/1/2013

Rule 4734-8-09 | Concussion management.

• Effective: January 30, 2021
• Promulgated Under: 119.03

(A) General population.

(1) Assessment, diagnosis and/or treatment of concussed patients shall be conducted in accordance with nationally accepted standards and guidelines. The licensee shall maintain a level of continuing education that keeps pace with the evolving topic of concussion management.

(2) A licensee may do all of the following in regard to concussion management:

(a) Assess;

(b) Diagnose;

(c) Treat;

(d) Grant clearance to return to activities of daily living;

(e) Consult with, refer to, or collaborate with other licensed healthcare providers.

(B) Youth athletes.

(1) As used in section 3313.535 of the Revised Code, "interscholastic extracurricular activity" means a pupil activity program that a school or school district sponsors or participates in and that includes participants from more than one school or school district. Interscholastic athletics apply to public schools, including schools operated by school districts, community schools, and science, technology, engineering, and math (STEM) schools and private schools, including both chartered and non-chartered public schools.

(2) As used in section 3707.51 of the Revised Code, "youth sports organization" means a public or nonpublic entity that organizes an athletic activity in which the athletes are not more than nineteen years of age and are required to pay a fee to participate in the athletic activity or whose cost to participate is sponsored by a business or nonprofit organization.

(3) As used in this rule, "youth athlete" means a participant in an interscholastic extracurricular activity under section 3313.539 of the Revised Code or a participant in a youth sports organization under section 3707.511 of the Revised Code.

(4) "Physician" means a person authorized under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery.

(5) Diagnosis and treatment of concussed youth athletes.

(a) Youth athletes shall be diagnosed and treated in accordance with the "consensus statement on concussion in sport - the 5th international conference on concussion in sport held in Berlin, October 2016" and adopted on March 6, 2017 (available from the website of the state chiropractic board at: http://www.chirobd.ohio.gov) or with nationally accepted standards and guidelines consistent with that statement.

(b) Each licensee who assesses, diagnoses and/or treats a concussed youth athlete shall maintain a level of continuing education that keeps pace with the evolving topic of concussion management.

(6) Assessment and clearance of concussed youth athletes.

(a) Subject to the exemptions provided in paragraph (B)(7) of this rule, licensees shall only make an assessment and/or grant clearance to a concussed youth athlete to return to play:

(i) In consultation with a physician;

(ii) Pursuant to the referral of a physician;

(iii) In collaboration with a physician;

(iv) Under the supervision of a physician.

(7) Exemptions.

(a) A licensee with one or more of the following current credentials is exempt from the provisions of paragraph (B)(6) of this rule and may assess and/or grant a clearance to return to play to a concussed youth athlete:

(i) Diplomate in chiropractic neurology recognized by the american chiropractic neurology board or the international board of chiropractic neurology;

(ii) Diplomate in chiropractic sports medicine recognized by the american chiropractic board of sports physicians;

(iii) Certified chiropractic sports physician recognized by the american chiropractic board of sports physicians and listed on the american chiropractic board of sports physicians national concussion registry.

Supplemental Information

Authorized By: 3707.521, 4734.10
Amplifies: 3313.539, 3707.511
Five Year Review Date: 3/21/2026
Prior Effective Dates: 1/1/2019

Rule 4734-8-10 | Telehealth.

• Effective: September 2, 2023
• Promulgated Under: 119.03

(A) In accordance with division (A)(6) of section 4743.09 of the Revised Code, telehealth services means health care services provided through the use of information and communication technology by a health care professional, within the professional's scope of practice, who is located at a site other than the site where either of the following is located:

(1) The patient receiving the services;

(2) Another health care professional with whom the provider of their services is consulting regarding the patient.

(B) A health care provider may use synchronous or asynchronous technology to provide telehealth services to a patient if the appropriate standard of care is satisfied.

(1) "Synchronous communication technology" means audio and/or video technology that permits two-way, interactive, real-time electronic communication between the health care professional and the patient or between the health care professional and the consulting health care professional regarding the patient.

(2) "Asynchronous communication technology" also called store and forward technology, has the same meaning as asynchronous store and forward technologies as that term is defined in 42 C.F.R. 410.78 (effective January 1, 2022).

(C) In accordance with division (A)(3)(g) of section 4743.09 of the Revised Code, a chiropractor licensed under Chapter 4734. of the Revised Code is a health care professional and may provide telehealth services.

(D) Unlicensed personnel are not defined as health care professionals under section 4734.09 of the Revised Code. A licensee shall not delegate telehealth services to unlicensed personnel.

(E) Provided that the standard of care for an in-person visit can be met for the patient and the patient's medical condition through the use of the technology selected, each licensee that performs telehealth services must comply with the provisions outlined in Chapter 4734. of the Revised Code and Chapter 4734. of the Administrative Code. The following provisions additionally apply to telehealth services:

(1) The licensee providing telehealth services must have an active Ohio license to practice chiropractic in the state of Ohio.

(2) The licensee must communicate their first and last name and ensure the patient understands their licensure status as a chiropractor prior to rendering telehealth services to the patient.

(3) The patient receiving telehealth services must be located within the state of Ohio. The licensee must verify the identity and physical location of the patient at the beginning of each telehealth visit.

(4) Consent to receive telehealth services must be documented in the medical record or signed authorization of the patient or, if applicable, the patient's parent, guardian, or person designated under the patient's health care power of attorney.

(5) The standard of care for a telehealth visit is the same as the standard of care for an in-person visit. If a licensee determines at any time during the provision of telehealth services that a telehealth visit will not meet the standard of care for the medical condition of the patient, or if additional in-person care is necessary, the licensee must schedule the patient for an in-person visit and conduct that visit within an amount of time that is appropriate for the patient and condition presented. If the patient needs emergency care, the licensee must help the patient identify the closest emergency room.

(6) A licensee must provide telehealth services in a manner that complies with all requirements under state and federal law regarding the protection of patient information. The licensee must ensure that any user name or password information and any electronic communication between the licensee and the patient is securely transmitted and stored. Photographs or video images that are visualized by a telecommunications system must be both specific to the patient's medical condition and sufficient for furnishing or confirming a diagnosis and/or a treatment plan.

(7) In accordance with section 3902.30 of the Revised Code, a licensee may not charge a patient or a health plan insurer covering telehealth services a facility fee, an origination fee, or any fee associated with the cost of the equipment used at the provider site to provide telehealth services.

(8) A licensee providing telehealth services may charge a health plan issuer for durable medical equipment used at the patient site.

(9) A licensee may negotiate with a health plan issuer to establish a reimbursement rate for fees associated with the administrative costs incurred providing telehealth services so long as a patient is not responsible for any portion of the fee.

(10) The licensee providing telehealth services must obtain the patient's consent before billing for the cost of providing the services, but the requirement to do so only applies once.

(11) A licensee may deny a patient telehealth services and require the patient to undergo an in-person visit.

(F) Nothing in this rule will prohibit an individual who is licensed as a chiropractor in a state other than Ohio from performing telehealth services for patients outside of Ohio if such telehealth services are permitted by:

(1) The laws of the state in which the individual has been authorized to practice chiropractic and,

(2) The location where the patient is located.

Last updated September 5, 2023 at 8:12 AM

Supplemental Information

Authorized By: 4734.10
Amplifies: 4743.09, 4734.10
Five Year Review Date: 9/2/2028