1. (a) Occupational Therapists, Registered or Licensed Occupational Therapists (OTRs or LOTs) are fully responsible for the planning and delivery of occupational therapy services.

   1. (1) The supervising OTR or LOT is responsible for providing the supervision necessary to protect the health and welfare of the consumer receiving OT services from a COTA, LOTA, temporary licensee or OT Aide or Orderly.
   2. (2) OTRs or LOTs must ensure that tasks appropriate for a COTA, LOTA or temporary licensee are not delegated to persons without current licenses.
   3. (3) The COTA, LOTA or temporary licensee is responsible for the execution of his or her professional duties.

2. (b) Supervision of a COTA or an LOTA.

   1. (1) The OTR or LOT shall delegate responsibilities to the COTA or LOTA that are within the scope of his or her training.

   2. (2) A COTA or LOTA shall provide occupational therapy services only under the general supervision of a licensed OTR or LOT. (See Chapter 362 of this title (relating to Definitions)).

      1. (A) General supervision (See Chapter 362 of this title (relating to Definitions)) of COTAs or LOTAs must be documented on an "Occupational Therapy Supervision Log" prescribed by the board. COTAs and LOTAs employed part time or with more than one employer shall prorate the required documented supervision.

         1. (i) The "Occupational Therapy Supervision Log" must be kept by the COTA or LOTA and a copy of this form must be maintained by each employer.
         2. (ii) The "Occupational Therapy Supervision Log" must be submitted to TBOTE with the COTA's or LOTA's renewal application.
      2. (B) The supervising OTR or LOT need not be physically present or on the premises at all times.

   3. (3) Except where otherwise restricted by rule, the supervising OTR or LOT may only delegate tasks to a COTA or LOTA that the OTR or LOT and COTA or LOTA agree are within the competency level of that COTA or LOTA.

      1. (A) A COTA or LOTA may initiate and perform the screening process and collect information for the OTR's or LOT's review. The OTR or LOT is responsible for determining if intervention is needed and if a physician's referral is required for evaluation and/or occupational therapy intervention.

      2. (B) An OTR or LOT is responsible for the patient's evaluation/assessment. The supervising OTR or LOT may delegate to a COTA or LOTA the collection of data or information for the evaluation.

         1. (i) The OTR or LOT is responsible for the accuracy of evaluative information collected by the COTA or LOTA.
         2. (ii) The OTR or LOT must have face-to-face interaction with the patient or client during the evaluation process.
      3. (C) Only an OTR or LOT may develop or modify an Occupational Therapy plan of care (refer to §362.1 of this title (relating to Definitions)).
      4. (D) The OTR or LOT is responsible for the content and validity of the discharge summary and must sign the discharge summary.
   4. (4) It is the responsibility of the OTR or LOT and the COTA or LOTA to ensure that all documentation prepared by the COTA or LOTA which becomes part of the patient's/client's permanent record is approved and co-signed by the supervising OTR or LOT. Occupational Therapy notes must be initialed by the OTR or LOT and signed at the bottom of each page.
   5. (5) These rules shall not preclude the COTA or LOTA from responding to emergency situations in the patient's condition which require immediate action.

3. (c) Supervision of an OT Aide or OT Orderly.

   1. (1) When an OTR, LOT, COTA and/or LOTA delegates OT tasks to an aide or orderly, the OTR, LOT, COTA and/or LOTA is responsible for the aide's actions during patient contact on the delegated tasks. The licensee is responsible for ensuring that the aide is adequately trained in the tasks delegated.
   2. (2) The OTR, LOT, COTA or LOTA must interact with the patient regarding the patient's condition, progress and/or achievement of goals during each treatment session.
   3. (3) An OTR, LOT, COTA and/or LOTA using OT Aide or OT Orderly personnel to assist with the provision of occupational therapy services must provide close personal supervision in order to protect the health and welfare of the consumer. (See Chapter 362 of this title (relating to Definitions)).

   4. (4) Delegation of tasks to OT Aides or OT Orderlies.

      1. (A) The primary function of an OT Aide or OT Orderly functioning in an occupational therapy setting is to perform designated routine tasks related to the operation of an occupational therapy service. An OTR, LOT, COTA and/or LOTA may delegate to an OT Aide or OT Orderly only specific tasks which are not evaluative or recommending in nature, and only after insuring that the OT Aide or OT Orderly has been properly trained for the performance of the tasks. Such tasks include, but are not limited to:

         1. (i) routine department maintenance;
         2. (ii) transportation of patients/clients;
         3. (iii) preparation or setting up of treatment equipment and work area;
         4. (iv) assisting patients/clients with their personal needs during treatment;
         5. (v) assisting in the construction of adaptive equipment and splints;
         6. (vi) clerical, secretarial, administrative activities;
         7. (vii) carrying out a predetermined segment or task in the patient's care.

      2. (B) The OTR, LOT, COTA and/or LOTA shall not delegate to an OT Aide or OT Orderly:

         1. (i) performance of occupational therapy evaluative procedures;
         2. (ii) initiation, planning, adjustment, modification, or performance of occupational therapy procedures requiring the skills or judgment of an OTR, LOT, COTA or LOTA;
         3. (iii) making occupational therapy entries directly in patients' or clients' official records;
         4. (iv) acting on behalf of the occupational therapist in any matter related to occupational therapy which requires decision making or professional judgment.

4. (d) Supervision of an occupational therapist or an occupational therapy assistant with a temporary license.

   1. (1) A person issued a temporary occupational therapy license must practice occupational therapy under the continuing supervision of an OTR or LOT. (See Chapter 362 of this title (relating to Definitions)).

   2. (2) A minimum of 16 hours of supervision per month for full time OTAs must be documented on an "Occupational Therapy Supervision Log" prescribed by the board. OTAs employed part time or with more than one employer shall prorate the required documented supervision. If the OTA is employed less than 20 hours per week, a minimum of eight hours of supervision is required per month.

      1. (A) The "Occupational Therapy Supervision Log" must be kept by the OTA and a copy of this form must be maintained by each employer.
      2. (B) The "Occupational Therapy Supervision Log" must be submitted to TBOTE with the COTA's first renewal application after regular licensure.
   3. (3) The temporary licensee must certify to the board the name, license number, and address of his or her supervisor on a form provided by the board during the application process.
   4. (4) The temporary licensee must notify the board within 15 days of a change in the OTR or LOT supervisor.
   5. (5) The temporary licensee shall not supervise an occupational therapy student, a COTA or LOTA, an occupational therapy assistant or an OT Aide or OT Orderly.
   6. (6) All documentation completed by an individual holding a temporary license which becomes part of the patient's/client's permanent file must be approved and co-signed by the supervising OTR or LOT. Occupational Therapy notes must be initialed by the OTR or LOT and signed at the bottom of each page.

5. (e) Supervision of Provisional Licensees.

   1. (1) OTRs and LOTs with provisional licenses are excluded from supervision requirements.
   2. (2) COTAs and LOTAs with provisional licenses will require general supervision by a licensed OTR or LOT.

Source Note:The provisions of this §373.1 adopted to be effective January 9, 1995, 19 TexReg 10361; amended to be effective August 31, 1995, 20 TexReg 6337; amended to be effective May 8, 1996, 21 TexReg 3716; amended to be effective March 5, 1997, 22 TexReg 1898; amended to be effective November 4, 1997, 22 TexReg 10752; amended to be effective October 25, 1998, 23 TexReg 11167.