A referral is required to treat a patient with physical therapy.

Exceptions

A physical therapist who has completed a doctor of physical therapy program approved by the Commission on Accreditation of Physical Therapy Education or who has obtained a certificate of authorization pursuant to § 54.1-3482.1 may evaluate and treat a patient for no more than thirty (30) consecutive days after an initial evaluation without a referral under the following conditions:

• The patient is not receiving care from any licensed doctor of medicine, osteopathy, chiropractic, podiatry, or dental surgery, a licensed nurse practitioner practicing in accordance with his practice agreement, or a licensed physician assistant acting under the supervision of a licensed physician for the symptoms giving rise to the presentation at the time of the presentation to the physical therapist for physical therapy services or
• The patient is receiving care from a licensed doctor of medicine, osteopathy, chiropractic, podiatry, or dental surgery, a licensed nurse practitioner practicing in accordance with his practice agreement, or a licensed physician assistant acting under the supervision of a licensed physician at the time of his presentation to the physical therapist for the symptoms giving rise to the presentation for physical therapy services; and
• The patient identifies a licensed doctor of medicine, osteopathy, chiropractic, podiatry, or dental surgery, a licensed nurse practitioner practicing in accordance with his practice agreement, or a licensed physician assistant acting under the supervision of a licensed physician from whom he is currently receiving care;
• The patient gives written consent for the physical therapist to release all personal health information and treatment records to the identified practitioner; and
• The physical therapist notifies the practitioner identified by the patient no later than fourteen (14) days after treatment commences and provides the practitioner with a copy of the initial evaluation along with a copy of the patient history obtained by the physical therapist.

Treatment for more than thirty (30) consecutive days after evaluation of such patient shall only be upon the referral and direction of a licensed doctor of medicine, osteopathy, chiropractic, podiatry, or dental surgery, a licensed nurse practitioner practicing in accordance with his practice agreement, or a licensed physician assistant acting under the supervision of a licensed physician. A physical therapist may contact the practitioner identified by the patient at the end of the thirty (30) day period to determine if the practitioner will authorize additional physical therapy services until such time as the patient can be seen by the practitioner.

A physical therapist shall not perform an initial evaluation of a patient if the physical therapist has performed an initial evaluation of the patient for the same condition within the immediately preceding sixty (60) days.

One-time Evaluation

A physical therapist who has not completed a doctor of physical therapy program approved by the Commission on Accreditation of Physical Therapy Education or who has not obtained a certificate of authorization pursuant to § 54.1-3482.1 may conduct a one-time evaluation that does not include treatment of a patient without the referral and direction of a licensed doctor of medicine, osteopathy, chiropractic, podiatry, or dental surgery, a licensed nurse practitioner practicing in accordance with his practice agreement, or a licensed physician assistant acting under the supervision of a licensed physician; if appropriate, the physical therapist shall immediately refer such patient to the appropriate practitioner.

Exception for Students and Public Welfare

A licensed physical therapist may provide, without referral or supervision, physical therapy services to:

• A student athlete participating in a school-sponsored athletic activity while such student is at such activity in a public, private, or religious elementary, middle or high school, or public or private institution of higher education when such services are rendered by a licensed physical therapist who is certified as an athletic trainer by the National Athletic Trainers' Association Board of Certification or as a sports certified specialist by the American Board of Physical Therapy Specialties;
• Employees solely for the purpose of evaluation and consultation related to workplace ergonomics;
• Special education students who, by virtue of their individualized education plans (IEPs), need physical therapy services to fulfill the provisions of their IEPs;
• The public for the purpose of wellness, fitness, and health screenings;
• The public for the purpose of health promotion and education; and
• The public for the purpose of prevention of impairments, functional limitations, and disabilities.

Invasive Procedures

Invasive procedures within the scope of practice of physical therapy shall at all times be performed only under the referral and direction of a licensed doctor of medicine, osteopathy, chiropractic, podiatry, or dental surgery, a licensed nurse practitioner practicing in accordance with his practice agreement, or a licensed physician assistant acting under the supervision of a licensed physician.

Certification for Direct Access

An applicant for certification to provide services to patients without a referral shall hold an active, unrestricted license as a physical therapist in Virginia and shall submit evidence satisfactory to the board that he has one of the following qualifications:

• Completion of a transitional program in physical therapy as recognized by the board; or
• At least three (3) years of post-licensure, active practice with evidence of fifteen (15) contact hours of continuing education in medical screening or differential diagnosis, including passage of a post-course examination. The required continuing education shall be offered by a provider or sponsor listed as approved by the board and may be face-to-face or online education courses.

In addition to the evidence of qualification for certification an applicant seeking direct access certification shall submit to the board:

• A completed application as provided by the board;
• Any additional documentation as may be required by the board to determine eligibility of the applicant; and
• The application fee ($75).

Documentation Requirements

A physical therapist providing services with a direct access certification shall utilize the Direct Access Patient Attestation and Medical Release Form prescribed by the board or otherwise include in the patient record the information, attestation and written consent.

Reference

Va. Code Ann. § 54.1-3482

Va. Code Ann. § 54.1-3482.1

18 VAC 112-20-81

18 VAC 112-20-90