1. (a) Initiation of physical therapy services.

   1. (1) Referral requirement. A physical therapist is subject to discipline from the board for providing physical therapy treatment without a referral from a qualified healthcare practitioner licensed by the appropriate licensing board, who within the scope of the professional licensure is authorized to prescribe treatment of individuals. The list of qualifying referral sources includes physicians, dentists, chiropractors, podiatrists, physician assistants, and advanced nurse practitioners.

   2. (2) Exceptions to referral requirement.

      1. (A) A PT may evaluate without referral.
      2. (B) A PT may provide instructions to any person who is asymptomatic relating to the instructions being given without a referral, including instruction to promote health, wellness, and fitness.
      3. (C) Emergency Circumstances. A PT may provide emergency medical care to a person after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity without referral if the absence of immediate medical attention could reasonably be expected to result in a serious threat to the patient's health, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

      4. (D) Prior referrals. A physical therapist may treat a patient for an injury or condition that is the subject of a prior referral if all of the following conditions are met.

         1. (i) The physical therapist must notify the original referring healthcare personnel of the commencement of therapy by telephone within five days, or by letter postmarked within five business days;
         2. (ii) The physical therapy provided must not be for more than 20 treatment sessions or 30 consecutive calendar days, whichever occurs first. At the conclusion of this time or treatment, the physical therapist must confer with the referring healthcare personnel before continuing treatment.
         3. (iii) The treatment can only be provided to a client/patient who received the referral not more than one year previously.
         4. (iv) The physical therapist providing treatment must have been licensed for one year. The physical therapist responsible for the treatment of the patient may delegate appropriate duties to another physical therapist having less than one year of experience or to a physical therapist assistant. A physical therapist licensed for more than one year must retain responsibility for and supervision of the treatment.

   3. (3) Methods of referral. A referral may be transmitted by a qualifying referral source in the following ways:

      1. (A) a document (including an electronically transmitted document or facsimile); or
      2. (B) verbally, in person or by telephone. If a referral is transmitted verbally, whether in person or by telephone, it must be received, recorded and signed by the PT, PTA or other authorized personnel, and include all of the information that would appear on a written referral.

2. (b) Evaluation and screening.

   1. (1) Evaluation. Physical therapy treatment may not be provided prior to the completion of an evaluation of the patient's condition by a PT.

   2. (2) Reevaluation. A patient receiving treatment must be reevaluated by a PT:

      1. (A) at least once every 30 days, or at a higher frequency as established by the PT; or
      2. (B) In response to a change in the patient's medical status that affects physical therapy treatment, when a change in the physical therapy plan of care is needed, or prior to any planned discharge.

      3. (C) A reevaluation must include:

         1. (i) An onsite reexamination of the patient, and
         2. (ii) A review of the plan of care with appropriate revision or termination.
   3. (3) PTAs may screen patients designated by a PT as possible candidates for physical therapy services. Screening entails the collection of uniform information from all patients screened using a predetermined, standardized format. The information collected is delivered to the supervising PT. Only a PT may determine whether further intervention for patients screened is necessary.

3. (c) Physical therapy plan of care development and implementation.

   1. (1) A written plan of care must be developed for each patient by a PT.
   2. (2) The plan of care must be updated following the periodic reevaluation of the patient's condition.
   3. (3) The plan of care or treatment goals may only be changed or modified by a PT.
   4. (4) Physical therapy treatment may not be provided by a PTA or an aide until a written plan of care, based on an evaluation by a PT, has been completed.
   5. (5) A PTA may modify treatment techniques as indicated in the plan of care.
   6. (6) A PT or PTA must interact with the patient regarding his/her condition, progress and/or achievement of goals during each treatment session.

4. (d) Documentation of treatment.

   1. (1) Each progress note in a patient's permanent record completed by a PTA must include the name of the supervising PT.
   2. (2) A PTA may not sign progress notes which design or modify the plan of care.
   3. (3) Physical therapy aides may not write or sign physical therapy documents in the permanent record. However, a physical therapy aide may record quantitative data for tasks delegated by the supervising PT or PTA. Any document reflecting aide activities must identify the aide and the supervising PT or PTA.
5. (e) Discharge. The supervising PT is responsible for the content and validity of the discharge summary and must sign it. A PTA may provide clerical assistance with a discharge summary.

Source Note:The provisions of this §322.1 adopted to be effective April 15, 1999, 24 TexReg 2935; amended to be effective November 19, 2001, 26 TexReg 9382; amended to be effective September 18, 2006, 31 TexReg 7998; amended to be effective February 18, 2008, 33 TexReg 1335.