Chapter 4755-27 Conduct of Licensees

4755-27-01 Physical therapy practice defined.

(A) In accordance with section 4755.48 of the Revised Code, only individuals licensed by the physical therapy section of the board may imply or claim to be able to practice physical therapy or provide physical therapy services.

(1) Only individuals licensed by the physical therapy section may use the words physical therapist, physical therapy, physical therapy services, physiotherapist, physiotherapy, physiotherapy services, physical therapy assistant, physical therapist assistant, physical therapy technician, or other words or insignia indicating or implying that the person is a physical therapist or physical therapist assistant.

(2) Only individuals licensed by the physical therapy section may use the letters PT, PhT, PTT, RPT, LPT, MPT, DPT, MSPT, CPT, cPT, PTA, or any other letters or insignia to indicate or imply that the person is licensed to practice as a physical therapist or physical therapist assistant.

(B) The practice of physical therapy, as used in Chapter 4755. of the Revised Code, means engaging in physical therapy, as defined in division (A) of section 4755.40 of the Revised Code, including providing consultative services.

(C) For the purpose of Chapters 4755-21 to 4755-29 of the Administrative Code, the following definitions shall apply:

(1) "Physical therapist" means an individual who performs the initial examination unless that physical therapist has transferred the responsibility for the management of the patient's care to another physical therapist and that physical therapist agrees to the transfer.

(2) "Physical therapist assistant" means an individual holding a valid license under sections 4755.40 to 4755.56 to assist in the provision of physical therapy treatments, including the provision of patient education and instruction under the supervision of a physical therapist.

(3) "Other licensed personnel" means any person holding an Ohio license to practice as a health care practitioner in a profession other than physical therapy, and not holding a valid license under sections 4755.40 to 4755.56 of the Revised Code, who is working under the direct supervision of a physical therapist or physical therapist assistant, as delegated by the physical therapist, and is performing tasks and duties related to the delivery of physical therapy.

(4) "Unlicensed personnel" means any person who is on the job trained and supports the delivery of physical therapy services by personally assisting the physical therapist, physical therapist assistant, student physical therapist and/or student physical therapist assistant while the physical therapist, physical therapist assistant, student physical therapist, and/or student physical therapist assistant is concurrently providing services to the same patient.

(5) "Student physical therapist" means a student enrolled in an accredited or candidacy status entry level physical therapist education program who is completing a required clinical education course.

(6) "Student physical therapist assistant" means a student enrolled in an accredited or candidacy status entry level physical therapist assistant education program who is completing a required clinical education course.

(7) "Supervising physical therapist" means the physical therapist who is available to supervise the physical therapist assistant, the student physical therapist or student physical therapist assistant, other licensed personnel, or unlicensed personnel. The supervising physical therapist may be the physical therapist who performed the initial examination or another physical therapist with whom that physical therapist has a formal or informal agreement.

(8) "Supervising physical therapist assistant" means the physical therapist assistant who is appropriately available to supervise the student physical therapist assistant, other licensed personnel, or unlicensed personnel.

(9) "Direct supervision" means the physical therapist or physical therapist assistant is in the same building and available to immediately respond to the needs of the patient. The physical therapist or physical therapist assistant shall have direct contact with the patient during each visit.

(10) "Telehealth" means the use of electronic communications to provide and deliver a host of health-related information and healthcare services, including, but not limited to physical therapy related information and services, over large and small distances.

(a) Telehealth encompasses a variety of healthcare and health promotion activities, including, but not limited to, education, advice, reminders, interventions, and monitoring of interventions.

(b) If a physical therapy patient is located in Ohio, the physical therapist or physical therapist assistant providing physical therapy services via telehealth must hold a valid license under sections 4755.40 to 4755.56 of the Revised Code.

R.C. 119.032 review dates: 02/04/2014 and 02/04/2019
Promulgated Under: 119.03
Statutory Authority: 4755.411
Rule Amplifies: 4755.40 , 4755.48
Prior Effective Dates: 5/26/78, 8/14/00, 5/1/08, 5/1/13

4755-27-02 Supervision.

(A) The physical therapist assistant, defined in division (C) of section 4755.40 of the Revised Code, is a skilled, technical person who assists in physical therapy treatment and related duties as assigned by the physical therapist. These duties are carried out under the supervision of the physical therapist, as defined in division (D) of section 4755.40 of the Revised Code and rule 4755-27-04 of the Administrative Code. The duties assigned may vary in accordance with the setting and organizational structure of the service, the scope, size, and volume of the services, and the needs of the patients to be served. The physical therapist assistant may carry out patient related duties, as well as responsibilities appropriate to the established physical therapy services.

(B) Physical therapist assistants are not qualified to:

(1) Interpret physician referrals;

(2) Conduct initial patient evaluations;

(3) Write initial or ongoing patient plans of care;

(4) Conduct re-evaluations of the patient or make changes to the patient plan of care; or

(5) Perform the discharge evaluation and complete the final discharge summary.

(C) The physical therapist assistant may review medical information and/or review the patient's medical history and past functional ability through verbal contact with medical persons, family or the patient. This information may then be used by the physical therapist to determine the need for a patient evaluation.

(D) The physical therapist assistant may progress a patient treatment program within the parameters of the plan of care as established by the supervising physical therapist.

(E) The physical therapist may assign treatment procedures beyond the scope of entry level physical therapist assistant practice in accordance with the physical therapist assistant's ability, provided that both the supervising physical therapist and the physical therapist assistant have documented training and demonstrated competency in the procedure.

R.C. 119.032 review dates: 02/04/2014 and 02/04/2019
Promulgated Under: 119.03
Statutory Authority: 4755.411
Rule Amplifies: 4755.40
Prior Effective Dates: 5/26/78, 2/1/92, 8/14/00, 5/1/05, 5/1/08

4755-27-03 Delegation.

(A) Delegation in physical therapy is the sole responsibility of the physical therapist.

(B) The responsibility for physical therapy care rendered by the physical therapist assistant, and other licensed personnel rests with the supervising physical therapist.

(C) The physical therapist performs the following, none of which may be delegated:

(1) Interpreting available information concerning the referral;

(2) Providing the initial evaluation;

(3) Developing the plan of care, including the short term and long term goals;

(4) Identifying and documenting precautions, special problems, contraindications, anticipated progress, and plans for reevaluation;

(5) Selecting and delegating only appropriate tasks in the plan of care;

(6) Designating or establishing channels of written and oral communication;

(7) Assessing the competence of the physical therapist assistant, other licensed personnel, and unlicensed personnel to perform assigned tasks;

(8) Directing and supervising the physical therapist assistant, other licensed personnel, and unlicensed personnel in delegated tasks; and

(9) Reevaluating and adjusting the plan of care, when necessary, and performing the final evaluation, determining discharge, and establishing the follow-up plan.

(D) The physical therapist may refer patients to another discipline, which is not considered delegation. A referral to another discipline, including a physician, shall be documented in the medical record.

(E) Delegation of duties or tasks to the physical therapist assistant must be done in accordance with the scope of practice of the physical therapist assistant.

(1) A physical therapist assistant may not initiate or alter the plan of care without prior evaluation by and approval of the supervising physical therapist.

(2) A physical therapist assistant may adjust a treatment procedure in accordance with a change in patient status within the established plan of care.

(3) A physical therapist assistant may respond to inquiries regarding patient status to appropriate parties within the healthcare system and within the protocol established by the supervising physical therapist.

(4) The physical therapist assistant shall refer inquiries regarding a patient's prognosis to the supervising physical therapist. The physical therapist assistant may reinforce the physical therapist's position regarding the patient's prognosis.

(5) The physical therapist assistant may gather historical information about a patient to perform a screening that may determine the need for physical therapy intervention. This type of screening does not include physical contact with the patient.

(6) The physical therapist assistant shall document in the medical record according to the established protocols. All documentation shall be co-signed by the supervising physical therapist.

(F) Delegation of tasks related to the operation and delivery of physical therapy to other licensed personnel must be done in accordance with the scope of practice of the other licensed personnel's professional license, education and training, the level of competence as determined by the supervising physical therapist, and in consideration of the patient's overall needs and medical status.

(1) The physical therapist or physical therapist assistant shall demonstrate involvement, in accordance with paragraph (F) of rule 4755-27-04 of the Administrative Code, in each treatment session in which a component of care is delegated.

(2) Documentation by the other licensed personnel is restricted to an accounting of the activities provided, which includes the patient's response to intervention. The remainder of the documentation is the responsibility of the supervising physical therapist or supervising physical therapist assistant.

(G) The unlicensed personnel may be assigned routine duties that assist in the delivery of physical therapy care and operations, such as:

(1) Maintenance and care of equipment and supplies;

(2) Preparation, maintenance, and cleaning of treatment areas;

(3) Transportation of patients;

(4) Office and clerical functions;

(5) Assisting patients preparing for, during, and at the conclusion of treatment (such as changing clothes, assisting during transfer, and altering position during treatment);

(6) Personally assisting the physical therapist, physical therapist assistant, student physical therapist, and/or student physical therapist assistant while the physical therapist, physical therapist assistant, student physical therapist, and/or student physical therapist assistant is concurrently providing services to the same patient.

R.C. 119.032 review dates: 02/04/2014 and 02/04/2019
Promulgated Under: 119.03
Statutory Authority: 4755.411
Rule Amplifies: 4755.411
Prior Effective Dates: 2/1/92, 7/8/96, 8/14/00, 5/1/04, 5/1/05, 5/1/06, 1/1/08, 5/1/08, 5/1/09

4755-27-04 Supervision.

(A) The supervising physical therapist is accountable and responsible at all times for the direction of the actions of the persons supervised, including the:

(1) Physical therapist assistant;

(2) Student physical therapist;

(3) Student physical therapist assistant;

(4) Other licensed personnel; and

(5) Unlicensed personnel.

(B) The supervising physical therapist assistant is accountable and responsible at all times for the direction of the actions of the persons supervised, including the:

(1) Student physical therapist assistant;

(2) Other licensed personnel; and

(3) Unlicensed personnel.

(C) Supervision of the physical therapist assistant.

(1) In accordance with division (C) of section 4755.40 of the Revised Code, a physical therapist assistant may only be supervised by a physical therapist and may not be supervised by any other person, including those persons licensed to practice in any other profession.

(2) Supervision for a physical therapist assistant does not require the supervising physical therapist to be on-site or on location. The supervising physical therapist must be available by telecommunication at all times and able to respond appropriately to the needs of the patient.

(D) Supervision of the student physical therapist.

(1) A student physical therapist may only be supervised by a physical therapist licensed pursuant to Chapter 4755. of the Revised Code.

(2) The supervising physical therapist is required to be on-site and available to immediately respond to the needs of the patient whenever the student physical therapist is performing patient examinations, evaluations, and interventions.

(E) Supervision of the student physical therapist assistant.

(1) A student physical therapist assistant may only be supervised by a physical therapist or physical therapist assistant licensed pursuant to Chapter 4755. of the Revised Code.

(2) The supervising physical therapist or supervising physical therapist assistant is required to be on-site and available to immediately respond to the needs of the patient whenever the student physical therapist assistant is performing patient interventions.

(F) Supervision of other licensed personnel.

Direct supervision from the supervising physical therapist or supervising physical therapist assistant is required whenever the other licensed personnel is performing patient interventions.

(G) Supervision of unlicensed personnel.

Unlicensed personnel may be supervised by the student physical therapist or student physical therapist assistant who are being supervised in accordance with the laws and rules governing the practice of physical therapy.

R.C. 119.032 review dates: 02/04/2014 and 02/04/2019
Promulgated Under: 119.03
Statutory Authority: 4755.411
Rule Amplifies: 4755.40 , 4755.411
Prior Effective Dates: 8/7/78, 2/1/92, 7/15/95, 3/20/99, 8/14/00, 5/1/06, 5/1/08, 5/1/09

4755-27-05 Code of ethical conduct for physical therapists and physical therapist assistants.

An individual licensed by the physical therapy section has a responsibility to report any organization or entity that provides or holds itself out to deliver physical therapy services that places the licensee in a position of compromise with this code of ethical conduct.

(A) Ethical integrity.

Licensees shall use the provisions contained in paragraphs (A) (1) to (A)(10) of this rule as guidelines for promoting ethical integrity and professionalism. Failure to comply with paragraphs (A)(1) to (A)(10) of this rule may be grounds for disciplinary action pursuant to section 4755.47 of the Revised Code and in accordance with Chapter 119. of the Revised Code.

(1) A licensee shall respect the rights and dignity of all patients and provide compassionate care as described in paragraphs (A)(1)(a) and (A)(1)(b) of this rule.

(a) A licensee shall recognize individual differences with patients and shall respect and be responsive to those differences.

(b) A licensee shall be guided by concern for the physical, psychosocial, and socioeconomic welfare of patients.

(2) A licensee shall exercise sound judgment and act in a trustworthy manner in all aspects of physical therapy practice. Regardless of practice setting, the physical therapist shall maintain the ability to make independent judgments. A licensee shall strive to effect changes that benefit patients.

(3) A licensee shall only seek compensation that is reasonable for the physical therapy services delivered. A licensee shall never place the licensee's own financial interests above the welfare of the licensee's patients. A licensee, regardless of the practice setting, shall safeguard the public from unethical and unlawful business practices.

(4) A licensee shall not intentionally or knowingly offer to pay or agree to accept any compensation, directly or indirectly, overtly or covertly, in cash or in kind, to or from any person or entity for receiving or soliciting patients or patronage, regardless of the source of the compensation.

(5) A licensee shall not influence a patient or the patient's family to utilize, purchase, or rent any equipment based on the direct or indirect financial interests of the licensee. Recommendations of equipment must be based solely on the therapeutic value of that equipment to the patient. A licensee who owns or has a direct financial interest in an equipment or supply company must disclose the financial interest to the patient if the licensee sells or rents, or intends to sell or rent, to the patient.

(6) A licensee shall ensure the patient's rights to participate fully in their care, including the patient's right to select the physical therapy provider, regardless of the practice setting.

(7) A licensee shall respect the rights, knowledge, and skills of colleagues and other health care professionals.

(8) A licensee shall safeguard the public from underutilization or overutilization of physical therapy services.

(9) A licensee shall provide accurate and relevant information to patients about the patients' care and to the public about physical therapy services.

(10) A licensee shall report to the physical therapy section any unprofessional, incompetent, or illegal behavior of a physical therapist or physical therapist assistant of which the licensee has knowledge.

(B) Ethical conduct.

Ethical conduct includes conforming to the minimal standards of acceptable and prevailing physical therapy practice. Conduct may be considered unethical regardless of whether or not actual injury to a patient occurred. Failure to comply with paragraphs (B)(1) to (B)(15) of this rule may be grounds for disciplinary action pursuant to section 4755.47 of the Revised Code and in accordance with Chapter 119. of the Revised Code.

(1) A licensee shall adhere to the standards of ethical practice by practicing in a manner that is moral and honorable. A licensee may be disciplined for violating any provision contained in division (A) of section 4755.47 of the Revised Code.

(2) A licensee shall not cheat or assist others in conspiring to cheat on the national physical therapy examination or the state jurisprudence examination.

(3) An individual shall not practice physical therapy without a valid license, or without holding student status, including:

(a) Practicing physical therapy while an individual's license is suspended or revoked.

(b) Practicing physical therapy with an expired license or when no longer enrolled as a student in an accredited entry level physical therapy educational program.

(4) A licensee shall obtain informed consent from the patient.

(a) A licensee, unless otherwise allowed by law, shall not provide patient care without disclosing to the patient or the patient's representative, the benefits, substantial risks, if any, or alternatives to the recommended examination or intervention.

(b) Information relating to the therapist-patient relationship is confidential and may not be communicated to a third party not involved in that patient's care without the prior written consent of the patient or the patient's representative, or unless otherwise allowed by law. Information must be disclosed when required by law for the protection of the patient or the public.

(5) A licensee shall adhere to the minimal standards of acceptable prevailing practice. Failure to adhere to minimal standards of practice, whether or not actual injury to a patient occurred, includes, but is not limited to:

(a) Failing to assess and evaluate a patient's status;

(b) Performing or attempting to perform techniques, procedures, or both in which the licensee is untrained by education or experience;

(c) Delegating physical therapy functions or responsibilities to an individual lacking the ability or knowledge to perform the function or responsibility in question;

(d) Causing, or permitting another person to cause, physical or emotional injury to the patient, or depriving the patient of the individual's dignity;

(e) Providing treatment interventions that are not warranted by the patient's condition or continuing treatment beyond the point of reasonable benefit to the patient.

(f) Practicing in a pattern of negligent conduct, which means a continued course of negligent conduct or of negligent conduct in performing the duties of the profession.

(g) Providing substandard care as a physical therapist assistant by exceeding the authority to perform components of physical therapy interventions selected by the supervising physical therapist or through a deliberate or negligent act or failure to act, whether or not actual injury to any person occurred.

(h) Abandoning the patient by inappropriately terminating the patient practitioner relationship by the licensee.

(i) Documenting or billing for services not actually provided.

(6) A licensee shall not engage in conduct that constitutes harassment or verbal or physical abuse of, or unlawful discrimination against, patients, students and/or colleagues.

(7) A licensee shall not engage in any sexual relationship or conduct, including dating, with any patient, or engage in any conduct that may reasonably be interpreted by the patient to be sexual, whether consensual or nonconsensual, while a therapist-patient relationship exists.

(a) A licensee shall not intentionally expose or view a completely or partially disrobed patient in the course of treatment if the exposure or viewing is not related to the patient diagnosis or treatment under current practice standards.

(b) A licensee shall not engage in a conversation with a patient that is sexually explicit and unrelated to the physical therapy plan of care.

(8) A licensee shall not engage in sexual harassment of patients, students, and/or colleagues. Sexual harassment includes, but is not limited to, making unwelcome sexual advances, requesting sexual favors, and engaging in other verbal or physical conduct of a sexual nature that results in:

(a) Withholding physical therapy services to a patient;

(b) Creating an intimidating, hostile, or offensive environment; or

(c) Interfering with the patient's ability to recover.

(9) A licensee shall not falsify, alter, or destroy patient/client records, medical records, or billing records without authorization. The licensee shall maintain accurate patient and/or billing records.

(10) A licensee shall not practice physical therapy while the ability to practice is impaired by alcohol, controlled substances, narcotic drugs, physical disability, mental disability, or emotional disability. If a licensee's or applicant's ability to practice is in question, the licensee shall submit to a physical or mental examination or drug/alcohol screens as requested by the physical therapy section to determine the applicant's or licensee's qualifications to practice physical therapy.

(11) A licensee shall not obtain, attempt to obtain, or deliver medications through means of misrepresentation, fraud, forgery, deception, and/or subterfuge.

(12) A licensee shall transfer the continuum of care of the patient, as appropriate, to another health care provider in the event of elective termination of physical therapy services by the licensee.

(13) A licensee shall not aid, abet, authorize, condone, or allow the practice of physical therapy by any person not legally authorized to provide services.

(14) A licensee shall not permit another person to use an individual's wall certificate, pocket identification card, license number, or national provider identifier, as defined in section 4755.56 of the Revised Code, for any illegal purpose.

(15) A licensee shall not misrepresent the credential, title, and/or specialty certifications held by the licensee.

(C) Cooperation.

In accordance with division (A)(24) of section 4755.47 of the Revised Code, licensees shall cooperate with an investigation by the physical therapy section. Failure to cooperate is conduct detrimental to the best interest of the public and grounds for disciplinary action. Cooperation includes responding fully and promptly to any questions raised by the physical therapy section and providing copies of the medical records and other documents requested by the physical therapy section. Failure to comply with paragraphs (C)(1) to (C)(7) of this rule may be grounds for disciplinary action pursuant to section 4755.47 of the Revised Code and in accordance with Chapter 119. of the Revised Code.

(1) A licensee shall respond fully and truthfully to a request for information from the physical therapy section.

(2) A licensee shall comply with a subpoena issued by the physical therapy section.

(3) A licensee shall provide information or document within the time frame specified by the physical therapy section.

(4) A licensee shall appear and provide information at an interview requested by the physical therapy section.

(5) A licensee shall not deceive, or attempt to deceive, the physical therapy section regarding any matter, including by altering or destroying any record or document.

(6) A licensee shall not interfere with an investigation or disciplinary proceeding by willful misrepresentation of facts before the agency or the physical therapy section, or by use of threats or harassment against any patient or witness to prevent the patient or witness from providing evidence in a disciplinary proceeding or any other legal action.

(7) A licensee shall not refuse to provide testimony in an administrative hearing.

R.C. 119.032 review dates: 02/04/2014 and 02/04/2019
Promulgated Under: 119.03
Statutory Authority: 4755.411
Rule Amplifies: 4755.47
Prior Effective Dates: 3/20/08, 5/1/09

4755-27-06 Reporting requirements.

A licensee shall self report to the physical therapy section, within thirty days, any of the items outlined in paragraphs (A) to (E) of this rule. Failure to comply with this rule may be grounds for disciplinary action pursuant to section 4755.47 of the Revised Code and in accordance with Chapter 119. of the Revised Code.

(A) Impairment by physical or mental illness, chemical use, or chemical dependency, that affects the applicant's or licensee's ability to practice with reasonable skill and safety.

(B) Conviction of a felony.

(C) Conviction of a misdemeanor when the act that constituted the misdemeanor occurred during the practice of physical therapy.

(D) The termination, revocation, or suspension of membership by a state or national physical therapy professional association.

(E) A positive drug and/or alcohol screening.

R.C. 119.032 review dates: 02/04/2014 and 02/04/2019
Promulgated Under: 119.03
Statutory Authority: 4755.411
Rule Amplifies: 4755.47
Prior Effective Dates: 3/20/08, 5/1/09, 5/1/12

4755-27-07 Documentation.

(A) All physical therapists shall use the credential "PT" following their signature to indicate licensure as a physical therapist.

(B) All physical therapist assistants shall use the credential "PTA" following their signature to indicate licensure as a physical therapist assistant.

(C) All student physical therapists shall use one of the following to indicate student status:

(1) Student physical therapist;

(2) Student PT; or

(3) SPT.

(D) All student physical therapist assistants shall use one of the following to indicate student status:

(1) Student physical therapist assistant;

(2) Student PTA; or

(3) SPTA.

(E) All documentation by student physical therapists and student physical therapist assistants shall be cosigned by the supervising physical therapist.

(F) Appropriate documentation is integral to all facets of physical therapy care. Reports written by the physical therapist assistant for inclusion in the patient's record shall be cosigned by the supervising physical therapist. The cosignature shall indicate that the supervising physical therapist reviewed the written note and agrees with the patient information in the written note. A handwritten signature or electronic signature is acceptable whenever a physical therapist or physical therapist assistant signs his or her name.

(1) Electronic signature means any of the following attached to or associated with an electronic record by an individual to authenticate the record:

(a) A code consisting of a combination of letters, numbers, characters, or symbols that is adapted or executed by an individual as that individual's electronic signature.

(b) A computer generated signature code created for an individual.

(c) An electronic image of an individual's handwritten signature created by using a digital writing apparatus.

(2) If an electronic documentation system is not capable of dual signatures, a physical therapist may enter a separate note within the same documentation system. This note shall:

(a) Reference the date(s) of the note(s) being reviewed with documentation referencing the review; and

(b) Document agreement with the notes entered by the physical therapist assistant and/or changes needed in the treatment plan.

(3) The physical therapist or physical therapist assistant must assure that the electronic signature can be tracked to a unique log in code used only by that individual.

R.C. 119.032 review dates: 02/04/2014 and 02/04/2019
Promulgated Under: 119.03
Statutory Authority: 4755.411
Rule Amplifies: 4755.411
Prior Effective Dates: 5/1/09