PURPOSE: This rule establishes standards of practice for licensed massage therapists including those licensed massage therapists performing chair and on-site (outcall) massages and provisionally licensed massage therapists.

1. (1) Competence.

   1. (A) Each massage therapist shall:

      1. 1. Practice within his/her own scope of

education, practice, and competence and refer clients to other health professionals when appropriate;

1. 2. Maintain in the records a copy of the

current massage therapy license and any advanced training by documentation; and

1. 3. Acknowledge the limitations of and

contraindications to massage therapy and will not encourage unjustified treatment.

1. (B) No massage therapist shall delegate professional responsibilities to a person who is not qualified or licensed to perform them.

1. (2) Dual Relationships.

   1. (A) No massage therapist shall:

      1. 1. Engage in any verbally or physically

abusive behavior with a client;

1. 2. Engage in sexual conduct with his/her

client(s) during a massage session;

1. 3. Exercise influence within a massage

therapist-client relationship for purposes of engaging a client in sexual activity during a massage session;

1. 4. Take unfair advantage of the client for

financial gain;

1. 5. Massage the genitals; or
2. 6. Massage the breast unless done by

physician prescription or by documented clinical indication by a therapist who holds certification or advanced training in techniques related to therapeutic treatment of mammary tissue.

1. (3) Client Welfare.

   1. (A) Each massage therapist shall:

      1. 1. Conduct their business and profes-

sional activities with honesty and integrity;

1. 2. Maintain professional liability insur-

ance coverage;

1. 3. Obtain and document written client

assessment information, prior to performing initial massage therapy services, which shall include but not be limited to the following:

1. A. Purpose for visit;
2. B. Presence of pain and the location;
3. C. Allergies;
4. D. Currently under the care of any

health or mental healthcare professional;

1. E. Current medication use and the

purpose;

1. F. Recent surgeries;
2. G. Preexisting conditions;
3. H. Written consent for treatment and

date signed; and

1. I. The massage therapist’s signature

and date of service;

1. 4. Update, at each session, the client

record which shall include:

1. A. Client assessment information

updated, if any changes or additions;

1. B. The date massage therapy services

were performed;

1. C. Type of services performed;
2. D. Length of treatment;
3. E. Outcome assessment (may not

apply to on-site/chair massage); and

1. F. The massage therapist’s signature

or initials;

1. 5. Maintain client records for at least

three (3) years;

1. 6. Provide privacy for the client while

the client is dressing and undressing;

1. 7. Provide appropriate draping during

treatment which includes draping at the gluteal cleft and genitals on males and females and the breasts on females;

1. 8. Modify or terminate treatment at the

client’s request regardless of prior consent;

1. 9. Exercise the right to refuse to treat

any person or part of the body for just and reasonable cause;

1. 10. Utilize universal precautions at all

times as defined in 4 CSR 197-1.010(4). This includes handwashing before and after each client and not knowingly exposing clients to contagious diseases;

1. 11. Provide adequate space around mas-

sage chair/table to allow for proper body mechanics and to minimize the spread of infection between tables/chairs;

1. 12. Maintain all equipment used to per-

form massage therapy services in a safe and sanitary condition, which shall include but not be limited to:

1. A. Covering any massage or steam

equipment that does not have an impervious barrier with a single service material;

1. B. Repairing all cuts and nicks in

upholstery;

1. C. Cleansing all equipment coming in

contact with a client, including hydrotherapy equipment, combs, brushes, showercaps, 20 CSR 2197-3

showers, tubs, and basins with an antibacterial agent between each client usage;

1. D. Performing a visual check of all

equipment for the presence of any liquid, oil and/or body fluid and if present, all equipment shall be cleansed by the application of an antibacterial agent prior to and between each client usage;

1. E. Face cradles and arm rests on all

massage chairs and tables must be cleaned with an antibacterial agent between each client regardless of whether or not a single service material was used;

1. F. Using all ice cubes only once and

then disposing of properly; and

1. G. Cleansing after each use and keep-

ing well maintained all ice and heat pack equipment;

1. 13. Store and dispense from suitable

containers all massage lubricants, which shall include but not be limited to oils, soaps, alcohol, powders, lotions, shampoos and salts in order to prevent contamination;

1. 14. Remove lubricants from containers

in a sanitary manner;

1. 15. Keep multiple use containers, such

as pump bottles and tubes, free of debris and sanitize between each client use and before refilling;

1. 16. Store massage lubricants separately

from cleaning supplies;

1. 17. Store massage lubricants in a fashion

to preserve their integrity;

1. 18. Use only clean linens and drapes;
2. 19. Store all single service materials and

linens off the floor in closed or covered shelves, containers, cabinets or closets;

1. 20. Furnish clean and fresh all single-

service materials and linens such as sheets, towels, gowns, and pillowcases used in the practice of massage for each individual client;

1. 21. All soiled linens and drapes shall be

professionally laundered or washed on a hot water setting with detergent and at least one (1) cup of bleach or an antibacterial agent used in accordance with product label instructions in a clothes washing machine and dried on a high heat setting in a dryer;

1. 22. No massage therapist shall store

dirty linens, trash cans, or refuse in the closed shelves, containers, cabinets or closets containing clean linens and single-service materials.

1. (4) Confidentiality of Clients.

   1. (A) Each massage therapist will safeguard verbal and written confidential information of the client, unless disclosure is required by law, court order, or authorized by the client.
   2. (B) Client records for massage therapy services not provided at a licensed massage ther- FINANCIAL INSTITUTIONS AND PROFESSIONAL REGISTRATION Division 2197—Board of Therapeutic Massage

apy business shall be maintained by the licensed massage therapist.

1. (5) Representation of Service.

   1. (A) Each massage therapist shall:

      1. 1. Disclose to the client the schedule of

fees for services prior to treatment; and

1. 2. Include in any advertisement for mas-

sage:

1. A. His/her name and license number;

and

1. B. When offering gratuitous services

or discounts in connection with professional services, clearly and conspicuously state whether or not additional charges may be incurred by related services and the possible range of such additional charges;

1. 3. Have available at all times proof of

licensure and photo identification which has been taken within the last two (2) years.

1. (B) No massage therapist shall:

   1. 1. Misrepresent directly or by implica-

tion his/her professional qualifications such as type of licensure, education, experience, or areas of competence;

1. 2. Falsify professional records;
2. 3. Advertise massage therapy services or

instruction which contain a false, fraudulent, misleading or deceptive statement or any form of sexual suggestiveness or explicit sexuality; or

1. 4. Dress or behave in a provocative man-

ner.

1. (6) Resolving Ethical Issues.

   1. (A) Each massage therapist:

      1. 1. Has a responsibility to notify the

board of any violation of the Standards of Practice of which the therapist has information and belief;

1. 2. Has an obligation to be familiar with

the Standards of Practice; and

1. 3. Shall cooperate with any investigation

or proceeding.

AUTHORITY: sections 324.245, RSMo Supp. 2003 and 324.262, RSMo 2000.* This rule originally filed as 4 CSR 197-3.010. Original rule filed Feb. 25, 2000, effective Sept. 30, 2000. Amended: Filed Nov. 26, 2003, effective June 30, 2004. Moved to 20 CSR 2197- 3.010, effective Aug. 28, 2006. *Original authority: 324.245, RSMo 1998, amended 1999, 2003 and 324.262, RSMo 1998, amended 1999.