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California Physical Therapy Identification and Notification

Individual Identification

A health care practitioner shall disclose, while working, his or her name and practitioner's license status, as granted by this state, on a name tag in at least 18-point type. A health care practitioner in a practice or an office, whose license is prominently displayed, may opt to not wear a name tag.

Use of the prefix “Dr.”

A licensed physical therapist who has received a doctoral degree in physical therapy (DPT) or a doctoral degree in a related health science may do the following:

  • In a written communication, use the initials DPT, PhD, or EdD, as applicable, following the licensee’s name.
  • In a written communication, use the title “Doctor” or the abbreviation “Dr.” preceding the licensee’s name, if the licensee’s name is immediately followed by an unabbreviated specification of the applicable doctoral degree held by the licensee.
  • In a spoken communication while engaged in the practice of physical therapy, use the title “doctor” preceding the person’s name, if the speaker specifies that he or she is a physical therapist.
  • A doctoral degree shall be granted by an institution accredited by the Western Association of Schools and Colleges or by an accrediting agency recognized by the National Commission on Accrediting or the United States Department of Education that the board determines is equivalent to the Western Association of Schools and Colleges.

A physical therapist who uses the title "Dr" is responsible to make sure that no person believes that they are a physician and surgeon. In the event that a complaint is received by the Board that a physical therapist is representing themselves as a physician and surgeon, the fact the complainant has that belief would indicate that the physical therapist had not met the burden of responsibility.

Practice Issue: Use of Prefix, Affix & Suffix

Notification to Patients

A licensed physical therapist engaged in the practice of physical therapy shall provide Form NTC 12-01 to each patient.

The notice shall be provided by at least one of the following methods:

  • Prominently posting Form NTC 12-01 in an area visible to patients on the premises where the licensee provides the licensed services; or
  • Providing the patient or the patient's representative with a copy of Form NTC-1201. An acknowledgement, signed and dated by the patient or the patient's representative, shall be retained in that patient's medical records demonstrating receipt.

    Form NTC 12-01 Translations:

    Spanish Translation

    Tagalog Translation

    Hindi Translation

    Russian Translation

    Simplified Chinese Translation

    Notice of Information Changes

    Address of Record. Every applicant and licensee shall provide an address to the Physical Therapy Board of California (Board) that will be designated as their address of record, which will be utilized for all official and formal communications from the Board, and which will be disclosed to the public. An applicant or a licensee need not provide a residence address as the address of record, but may use an alternative address, such as a business address or a P.O. Box, as their address of record. Every applicant and licensee shall report any change of the address of record to the Board no later than thirty (30) calendar days after the address change has occurred. The report of change of address of record shall be in writing and contain the old address, the new address, and the effective date of the change of address.

    Residence Address. Every applicant and licensee shall provide a residence address to the Board. Only if the applicant or licensee also provides an alternative address of record as described in subdivision (a) above shall the Board maintain the residence address as confidential. Every applicant and licensee shall report any change of their residential address to the Board no later than thirty (30) calendar days after the address change has occurred. The report of change of residential address shall be in writing and contain the old address, the new address, and the effective date of the change of address.

    Name Change. Every applicant and licensee shall report to the Board in writing each and every change of name no later than thirty (30) calendar days after each change has occurred, giving both the old and new names.

    E-mail Address. Every applicant and licensee shall file a current e-mail address with the Board and shall notify the Board in writing of any and all changes of the e-mail address no later than thirty (30) calendar days after the change has occurred, giving both the old e-mail address and the new e-mail address. E-mail addresses are confidential information and shall not be made available to the public. This subdivision does not require an applicant or licensee to obtain an e-mail address, it only requires that person report an existing e-mail address to the Board.

    Forms:

    Request for Address Change

    Request for Name Change

    Citations

    16 CCR § 1398.15

    16 CCR § 1398.6



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