Section .0100 - Physical Therapists

Link to law: http://reports.oah.state.nc.us/ncac/title 21 - occupational licensing boards and commissions/chapter 48 - physical therapy examiners/subchapter c/subchapter c rules.html
Published: 2015

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subchapter 48C - SCOPE OF PHYSICAL THERAPY PRACTICE

 

section .0100 - PHYSICAL THERAPISTS

 

21 NCAC 48C .0101          PERMITTED PRACTICE

(a)  Physical therapy is presumed to include any acts,

tests, procedures, modalities, treatments, or interventions that are routinely

taught in educational programs or in continuing education programs for physical

therapists and are routinely performed in practice settings.

(b)  A physical therapist who employs acts, tests, procedures,

modalities, treatments, or interventions in which professional training has

been received through education or experience is considered to be engaged in

the practice of physical therapy.

(c)  A physical therapist must supervise physical therapist

assistants, physical therapy aides, PT students and PTA students to the extent

required under the Physical Therapy Practice Act and the rules in this Chapter. 

Physical therapy aides include all non-licensed individuals aiding in the

provision of physical therapy services.

(d)  The practice of physical therapy includes tests of

joint motion, muscle length and strength, posture and gait, limb length and

circumference, activities of daily living, pulmonary function, cardio‑vascular

function, nerve and muscle electrical properties, orthotic and prosthetic fit and

function, sensation and sensory perception, reflexes and muscle tone, and

sensorimotor and other skilled performances; treatment procedures such as

hydrotherapy, shortwave or microwave diathermy, ultrasound, infra‑red and

ultraviolet radiation, cryotherapy, electrical stimulation including

transcutaneous electrical neuromuscular stimulation, massage, debridement,

intermittent vascular compression, iontophoresis, machine and manual traction

of the cervical and lumbar spine, joint mobilization, machine and manual

therapeutic exercise including isokinetics and biofeedback; and training in the

use of orthotic, prosthetic and other assistive devices including crutches,

canes and wheelchairs.  Physical therapy further includes:

(1)           examining (history, system review and tests

and measures) individuals in order to determine a diagnosis, prognosis, and

intervention within the physical therapist's scope of  practice.  Tests and

measures include the following:

(A)          aerobic capacity and endurance;

(B)          anthropometric characteristics;

(C)          arousal, attention, and cognition;

(D)          assistive and adaptive devices;

(E)           community and work (job/school/play) integration or

reintegration;

(F)           cranial nerve integrity;

(G)          environmental, home, and work (job/school/play)

barriers;

(H)          ergonomics and body mechanics;

(I)            gait, locomotion, and balance;

(J)            integumentary integrity;

(K)          joint integrity and mobility;

(L)           motor function;

(M)         muscle performance;

(N)          neuromotor development and sensory integration;

(O)          orthotic, protective and supportive devices;

(P)           pain;

(Q)          posture;

(R)          prosthetic requirements;

(S)           range of motion;

(T)           reflex integrity;

(U)          self-care and home management;

(V)          sensory integrity; and

(W)         ventilation, respiration, and circulation.

(2)           alleviating impairment and functional

limitation by designing, implementing, and modifying therapeutic interventions

that include the following:

(A)          coordination, communication and documentation;

(B)          patient/client-related instruction;

(C)          therapeutic exercise (including aerobic

conditioning);

(D)          functional training in self-care and home management

(including activities of daily living and instrumental activities of daily

living);

(E)           functional training in community and work

(jobs/school/play) integration or reintegration activities (including

instrumental activities of daily living, work hardening, and work

conditioning);

(F)           manual therapy techniques (including mobilization

and manipulation);

(G)          prescription, application, and fabrication of

assistive, adaptive, orthotic, protective, supportive, and prosthetic devices

and equipment that is within the scope of practice of physical therapy;

(H)          airway clearance techniques;

(I)            wound management;

(J)            electrotherapeutic modalities; and

(K)          physical agents and mechanical modalities.

(3)           preventing injury, impairment, functional

limitation, and disability, including the promotion and maintenance of fitness,

health, and quality of life in all age populations.

 

History Note:        Authority G.S. 90‑270.24; 90‑270.26;

Eff. December 30, 1985;

Amended Eff. December 1, 2006; April 1, 2003; August 1,

2002; August 1, 1998; December 1, 1990; October 1, 1989; April 1, 1989.

21 NCAC 48C .0102          RESPONSIBILITIES



(a)  A physical therapist shall determine the patient care

plan and the elements of that plan appropriate for delegation.

(b)  A physical therapist shall determine that those persons

acting under his or her supervision possess the competence to perform the

delegated activities.

(c)  A physical therapist may delegate responsibilities to

physical therapist assistants, including supervising physical therapist or

physical therapist assistant students.

(d)  A physical therapist shall enter and review chart

documentation, reexamine and reassess the patient, and revise the patient care

plan if necessary, based on the needs of the patient.

(e)  A physical therapist shall establish a discharge plan

that includes a discharge summary or episode of care for each patient.

(f)  The physical therapist shall provide all therapeutic

interventions that require the physical therapist's expertise, and may delegate

to a physical therapist assistant or physical therapy aide the delivery of

service to the patient when it is safe and effective for the patient.

(g)  A physical therapist's responsibility for patient care

management includes first-hand knowledge of the health status of each patient

and oversight of all documentation for services rendered to each patient,

including awareness of fees and reimbursement structures.

(h)  A physical therapist shall be immediately available in

person or by telecommunication to a physical therapist assistant supervising a

physical therapy aide or student engaging in patient care.

(i)  A physical therapist who is supervising a physical

therapy aide or student shall be present in the same facility when patient care

is provided.

(j)  A physical therapist shall clinically supervise only

that number of assistive personnel, including physical therapist assistants,

physical therapy aides, and students completing clinical requirements, as the

physical therapist determines is appropriate for providing safe and effective

patient interventions at all times.

(k)  If a physical therapist assistant or physical therapy

aide is involved in the patient care plan, a physical therapist shall reassess

a patient every 60 days or 13 visits, whichever occurs first.

(l)  A physical therapist shall document every evaluation

and intervention or treatment including the following elements:

(1)           authentication (signature and designation)

by the physical therapist who performed the service;

(2)           date of the evaluation or treatment;

(3)           length of time of total treatment session

or evaluation;

(4)           patient status report;

(5)           changes in clinical status;

(6)           identification of specific elements of each

intervention or modality provided. Frequency, intensity, or other details may

be included in the plan of care and if so, do not need to be repeated in the

daily note;

(7)           equipment provided to the patient; and

(8)           interpretation and analysis of clinical

signs, symptoms, and response to treatment based on subjective and objective

findings, including any adverse reactions to an intervention.

(m)  At the time of reassessment the physical therapist shall

document:

(1)           the patient's response to therapy

intervention;

(2)           the patient's progress toward achieving

goals; and

(3)           justifications for continued treatment.

(n)  A physical therapist shall, upon request by the patient

of record, provide the original or copies of the patient's treatment record to

the patient, or to the patient's designee.  As permitted by G.S. 90-411,

a fee may be charged for the cost of reproducing copies.  The documents

requested shall be provided within 30 days of the request and shall not be contingent

upon current, past, or future physical therapy treatment or payment of

services.

 

History Note:        Authority G.S. 90-270.24; 90-270.26;

90-270.31; 90-270.34; 90-411;

Eff. December 30, 1985;

Amended Eff. February 1, 2015; July 1, 2013; December 1,

2006; August 1, 2002; August 1, 1998; January 1, 1991.

 

21 NCAC 48C .0103          PROHIBITED PRACTICE

(a)  A physical therapist must not employ acts, tests,

procedures, modalities, treatments, or interventions in the treatment of

patients that are beyond the scope of the practice of physical therapy.  Any

patient whose condition requires medical diagnosis of disease or treatment

beyond the scope of physical therapy must be referred as specified in G.S.

90-270.35.

(b)  A physical therapist must not permit any person working

under his or her supervision to engage in acts or practices beyond the scope

allowed by the Physical Therapy Practice Act or the rules in this Chapter.

(c)  Physical therapy does not include the application of

roentgen rays or radioactive materials, but consistent with the requirements of

G.S. 90-270.35(4) a physical therapist may review x-rays and may also request

radiologic consultations; however, a physical therapist shall not order

radiological examinations.

 

History Note:        Authority G.S. 90‑270.24; 90‑270.26;

90‑270.35;

Eff. December 30, 1985;

Amended Eff. December 1, 2006; August 1, 1998; April 1,

1989.

 

section .0200 – physical therapist assistants

 

21 NCAC 48C .0201          SUPERVISION BY PHYSICAL THERAPIST

(a)  A physical therapist assistant may assist in the

practice of physical therapy only to the extent allowed by the supervising

physical therapist.

(b)  A physical therapist assistant may make modifications

of treatment programs that are consistent with the established patient care

plan.

(c)  A physical therapist assistant may engage in off-site

patient related activities that are appropriate for the physical therapist

assistant's qualifications and the status of the patient.

(d)  A physical therapist assistant may document care

provided without the co-signature of the supervising physical therapist.

(e)  A physical therapist assistant who is supervising a physical

therapy aide or student must be present in the same facility when patient care

is provided.

(f)  The physical therapist assistant must document every

intervention/treatment, which must include the following elements:

(1)           Authentication (signature and designation)

by the physical therapist assistant who performed the service;

(2)           Date of the intervention/treatment;

(3)           Length of time of total treatment session;

(4)           Patient status report;

(5)           Changes in clinical status;

(6)           Identification of specific elements of each

intervention/modality provided.  Frequency, intensity, or other details may be

included in the plan of care and if so, do not need to be repeated in the daily

note;

(7)           Equipment provided to the patient or

client; and

(8)           Response to treatment based on subjective

and objective findings, including any adverse reactions to an intervention.

 

History Note:        Authority G.S. 90‑270.24; 90‑270.26;

90‑270.35;

Eff. December 30, 1985;

Amended Eff. December 1, 2006; August 1, 2002.

 

21 NCAC 48C .0202          PROHIBITED PRACTICE

(a)  A physical therapist assistant shall not engage in

practices requiring the knowledge and skill of a physical therapist.

(b)  A physical therapist assistant shall not engage in acts

beyond the scope of practice delegated by the supervising physical therapist.

 

History Note:        Authority G.S. 90‑270.24; 90‑270.26;

90‑270.35;

Eff. December 30, 1985.

 

 

 

 

SECTION .0300 ‑ RECENT GRADUATES

 

 

21 NCAC 48C .0301          PERMITTED ACTIVITIES

21 NCAC 48C .0302          AUTHORIZATION

 

History Note:        Authority G.S. 90‑270.24; 90‑270.26;

90‑270.31;

Eff. December 30, 1985;

Amended Eff. April 1, 1989; May 1, 1988;

Repealed Eff. August 1, 1998.

 

 

 

 

 

SECTION .0400 ‑ PHYSICAL THERAPY AIDES

 

 

21 NCAC 48C .0401          DEFINITION

Whenever any person not licensed in accordance with the

provisions of the physical therapy practice act aids in the provision of

physical therapy services under the supervision of a licensed physical

therapist or physical therapist assistant, that person meets the definition of

a physical therapy aide found in G.S. 90-270.24(5).

 

History Note:        Authority G.S. 90-270.24; 90-270.26;

Eff. August 1, 1998.

 

 

 

21 NCAC 48C .0402          FUNCTION

(a)  A physical therapy aide may perform only those acts

delegated by a licensed physical therapist or physical therapist assistant.

(b)  A physical therapy aide must not engage in the

performance of physical therapy activities without supervision by a licensee in

accordance with this Subchapter.

(c)  A physical therapy aide must work under the supervision

of a licensee who is present in the facility.  This may extend to an off-site

setting only when the physical therapy aide is accompanying and working

directly with a licensee with a specific patient.

(d)  A physical therapy aide must not be independently

responsible for a patient caseload.

 

History Note:        Authority G.S. 90‑270.24; 90‑270.26;

Eff. December 30, 1985;

Amended Eff. December 1, 2006; August 1, 2002; August 1,

1998.

 

 

SECTION .0500 ‑ PHYSICAL THERAPY STUDENTS

 

 

21 NCAC 48C .0501          EXEMPTION FOR STUDENTS

(a)  Students enrolled in educational programs that are

either accredited or are candidates in good standing for accreditation by an

agency recognized by either the U.S. Office of Education or the Council on

Postsecondary Accreditation, are included in the exemption from licensure

contained in G.S. 90‑270.34(a)(1) while completing a clinical requirement

for graduation.

(b)  A licensee must be present in the facility when patient

care activities are undertaken by a PT or PTA student while completing the

clinical requirement.

 

History Note:        Authority G.S. 90‑270.26(1); 90‑270.29;

90‑270.34(a)(1);

Recodified From 48E .0101(c) Effective January 25, 1989;

Amended Eff. January 1, 1991.

 

 

 

 

SECTION .0600 – OTHER ASSISTIVE PERSONNEL

 

21 NCAC 48C .0601          RESPONSIBILITIES

Health care personnel who do not function as physical

therapy aides may receive direction from physical therapists with regard to

patient related activities, but they must not either refer to or represent

their services as physical therapy.

 

History Note:        Authority G.S. 90-270.34(b)(2);

90-270.24(4);

Eff. August 1, 2002.