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California Physical Therapy Direct Access and Referrals

Direct Access and Conditions

A person may initiate physical therapy treatment directly from a licensed physical therapist if the treatment is within the scope of practice of physical therapists and all of the following conditions are met:

Duty to Refer

If, at any time, the physical therapist has reason to believe that the patient has signs or symptoms of a condition that requires treatment beyond the scope of practice of a physical therapist or the patient is not progressing toward documented treatment goals as demonstrated by objective, measurable, or functional improvement, the physical therapist shall refer the patient to a person holding a physician and surgeon’s certificate issued by the Medical Board of California or by the Osteopathic Medical Board of California or to a person licensed to practice dentistry, podiatric medicine, or chiropractic.

Disclosure of Financial Interest

The physical therapist shall disclose to the patient any financial interest he or she has in treating the patient and, if working in a physical therapy corporation, shall comply with Article 6 (commencing with Section 650) of Chapter 1.

Notification to Patient’s Physician

With the patient’s written authorization, the physical therapist shall notify the patient’s physician and surgeon, if any, that the physical therapist is treating the patient.

Visit Limitations

The physical therapist shall not continue treating the patient beyond forty-five (45) calendar days or twelve (12) visits, whichever occurs first, without receiving, from a person holding a physician and surgeon’s certificate from the Medical Board of California or the Osteopathic Medical Board of California or from a person holding a certificate to practice podiatric medicine from the California Board of Podiatric Medicine and acting within his or her scope of practice, a dated signature on the physical therapist’s plan of care indicating approval of the physical therapist’s plan of care. Approval of the physical therapist’s plan of care shall include an in-person patient examination and evaluation of the patient’s condition and, if indicated, testing by the physician and surgeon or podiatrist.

Wellness Exception

The conditions above do not apply to a physical therapist when he or she is only providing wellness physical therapy services to a patient

Patient Notice Requirements

When a person initiates physical therapy treatment services directly, pursuant to this section, the physical therapist shall not perform physical therapy treatment services without first providing the following notice to the patient, orally and in writing, in at least 14-point type and signed by the patient:

“Direct Physical Therapy Treatment Services

You are receiving direct physical therapy treatment services from an individual who is a physical therapist licensed by the Physical Therapy Board of California.

Under California law, you may continue to receive direct physical therapy treatment services for a period of up to forty-five (45) calendar days or twelve (12) visits, whichever occurs first, after which time a physical therapist may continue providing you with physical therapy treatment services only after receiving, from a person holding a physician and surgeon’s certificate issued by the Medical Board of California or by the Osteopathic Medical Board of California, or from a person holding a certificate to practice podiatric medicine from the California Board of Podiatric Medicine and acting within his or her scope of practice, a dated signature on the physical therapist’s plan of care indicating approval of the physical therapist’s plan of care and that an in-person patient examination and evaluation was conducted by the physician and surgeon or podiatrist.

Patient’s Signature/Date”

Physical Therapists and Physical Therapist Assistants Receiving and Documenting Verbal Orders from a Physician

A physical therapist's license does not preclude them from performing a function that does not require a license. Considering this, the Committee concluded that in this situation a physical therapist would be acting as a layperson, someone not licensed (e.g. receptionist, clerical staff, janitor, etc.), and could receive and document verbal orders from a physician. However, the ability of the layperson to receive and document verbal orders would be dependent on policy and procedures established by the facility.

A similar inquiry regarding whether or not a physical therapist assistant could receive and document telephone orders from a physician regarding a physical therapy patient was presented to the Practice Issues Committee at their meeting on February 26, 1998. In response to that inquiry, the Committee opined that a physical therapist assistant can take telephone orders from a physician providing the physical therapist assistant documents the orders in the patient record, does not alter the treatment plan and apprizes the supervising physical therapist of the orders.

Practice Issue: Physical Therapists and Physical Therapist Assistants Receiving and Documenting Verbal Orders from a Physician

Citations

Cal. Bus. and Prof. Code § 2620

Cal. Bus. and Prof. Code § 2620.1



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