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.