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Tennessee PT Direct Access and Referrals 

No person shall practice physical therapy other than upon the referral of a patient by a person who is licensed in this or another state to practice medicine, chiropractic, dentistry, osteopathic medicine or podiatric medicine, within the scope of those practices, and whose license is in good standing and who holds a CPR certificate or its equivalent, unless one of the following conditions is met:

    • Holds a master’s or doctorate degree from a professional physical therapy program that is accredited by a national accreditation agency recognized by the U.S. Department of Education and by the Board of Physical Therapy. The physical therapist must also have completed at least one (1) year of experience as a licensed physical therapist. The person has successfully completed a residency or clinical fellowship in physical therapy at a program approved by the board; OR
    • Has successfully completed a residency or clinical fellowship in physical therapy at a program approved by the Board of Physical Therapy. The Board of Physical Therapy has approved fellowships and residencies approved by the American Physical Therapy Association and the Academy of Orthopedic Manual Physical Therapists; OR
    • Has completed at least three (3) years of experience as a licensed physical therapist and successfully completed a physical therapy screening course that is approved by the Board of Physical Therapy and offered by an accredited university that consists of at least fifteen (15) contact hours. (Tenn. Code Ann. § 63-13-303(b)(3) The Board of Physical Therapy has approved the following courses: a. Any physical therapy screening course offered by an accredited university. b. Any physical therapy screening course that meets the following criteria:
      • Any physical therapy screening course offered by an accredited university.
      • Any physical therapy screening course that meets the following criteria:
        • The course consists of at least fifteen (15) contact hours and is taught by health professionals who hold a regular or clinical faculty appointment in a physical therapy educational program.
        • The course identifies that signs and symptoms of systemic disease that are not appropriate for physical therapy intervention without prior examination by a primary health care practitioner, including the signs and symptoms of cancer and diseases of the cardiopulmonary, neurological, and musculoskeletal systems.
        • The course teaches participants the decision-making process for determining when patients/clients require further examination or consultation by a physical therapist or referral to another health care practitioner.
        • The course integrates the process of making an appropriate and timely referral to another health care provider into the physical therapy examination and evaluation.

Exceptions

The initial evaluation which may be conducted without such referral.

The practice of physical therapy shall be under the written or oral referral of a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy, except a licensed physical therapist may:

    • Conduct an initial evaluation of a patient without referral;
    • Provide physical assessments or instructions, including a recommendation of exercise to an asymptomatic person, without the referral of a referring practitioner;
    • In emergency circumstances, including minor emergencies, provide assistance to a person to the best of a therapist's ability without the referral of a referring practitioner. The physical therapist shall refer the person to the appropriate health care practitioner, as indicated, immediately after providing assistance.

Emergency medical care" means bona fide emergency services provided after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to result in:

    • Placing the patient's health in serious jeopardy;
    • Serious impairment to bodily functions; or
    • Serious dysfunction of any bodily organ or part.

A Physical Therapist may treat a patient without a referral when all of the following apply:

When a patient provides the name of a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy and expressly wants the physical therapist to inform that physician, the physical therapist shall inform the patient's licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy no later than five (5) business days after the evaluation. A consultation shall occur between the physical therapist and the patient's licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy within the first six (6) visits or fifteen (15) business days, whichever comes first, of the findings of the patient's initial visit for physical therapy and any subsequent visits. Should that consultation not take place, no further therapy beyond the six (6) visits or fifteen (15) days, whichever comes first, shall be delivered;

When a patient does not provide the name of a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy or expressly states to the therapist that the patient does not want a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy informed of the initiation of therapy services, the therapist shall have the patient sign a consent form that confirms the patient either does not have a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy or does not want a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy informed of the initiation of therapy treatment. The consent form shall be maintained in the patient's record;

If the patient presents to the physical therapist for a problem for which the patient has been seen by a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy within the past twelve (12) months, the consent of the patient is not necessary to inform that licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy of the presentation for the physical therapy treatment. If the patient has no licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy, then the physical therapist shall make a suggestion from the list of available providers and shall inform the patient of the thirty (30) day limitation

If the physical therapist determines, based on reasonable evidence, that no substantial progress has been made with respect to that patient within fifteen (15) calendar days or six (6) visits, whichever occurs first, immediately following the date of the patient's initial visit with the physical therapist, the physical therapist shall not provide any additional physical therapy services and shall refer the patient to a licensed physician, doctor of chiropractic, dentist, podiatrist or osteopath. If the patient previously was diagnosed with chronic, neuromuscular or developmental conditions by a physician, doctor of chiropractic, dentist, podiatrist or osteopath and the evaluation, treatment or services are being provided for problems or symptoms associated with one (1) or more of those previously diagnosed conditions, then shall not apply. If a patient returns to the physical therapist within ninety (90) days of treatment with the same complaint, then the physical therapist shall make an immediate referral to the appropriate health care provider;

When a patient's licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy has not been notified of the physical therapy services, under no circumstances should therapy services continue beyond thirty (30) days immediately following the date of the patient's first visit;

It shall be considered unprofessional conduct for a physical therapist to knowingly initiate services for the same complaint for which a patient:

    • Has started therapy services but another therapist did not inform a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy within five (5) business days of the initial evaluation;
    • Has reached the fifteen (15) day and six (6) visit limit imposed where no substantial progress has been made from another physical therapist; or
    • Has reached the thirty (30) day limit;

This does not apply if a referral from a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy is made.

When a Referral to Other Practitioners is Required

A physical therapist shall refer persons under the physical therapist's care to appropriate health care practitioners, after consultation with the referring practitioner, if the physical therapist has reasonable cause to believe symptoms or conditions are present that require services beyond the scope of practice or when physical therapy treatment is contraindicated.

Citation

Tenn. Code Ann. § 63-13-104

Tenn. Code Ann. § 63-13-302

Tenn. Comp. R. & Regs. 1150-01-.02

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