The Physical Therapy Program covers medically necessary physical therapy services ordered in writing by a physician, doctor of dental surgery or of dental medicine, physician assistant, nurse practitioner, nurse midwife, or podiatrist when the services are: Provided by a licensed physical therapist or by a licensed physical therapist assistant under a licensed physical therapist's direct supervision; Provided in the provider’s office, the patient’s home, a domiciliary level facility, or via telehealth in accordance with COMAR 10.09.49 or other subregulatory guidance issued by the Department; Diagnostic, rehabilitative, or therapeutic, and directly related to the written treatment order; Of sufficient complexity and sophistication, or the condition of the patient is such, that the services of a physical therapist are required; Rendered pursuant to a written treatment order which: Is signed and dated by the prescriber; Specifies the following: Part or parts to be treated; and Expected results of physical therapy treatments; Is kept on file by the therapist as a part of the patient's permanent record, subject to review by the Department or its designee; and Is not altered by the therapist unless: Medically indicated; Signed by the therapist; Necessary changes are made; The prescriber is notified of the change; and The change is noted in the patient's record; and Recorded in the patient's permanent record which includes: The treatment order of the prescriber; The initial evaluation by the therapist and significant past history; All pertinent diagnoses and prognoses; Contraindications, if any; and Progress notes documented in accordance with the requirements listed in COMAR 10.38.03.02-1A(2), C, and D. The Physical Therapy Program covers an initial evaluation, on a one-time-only basis, per condition, when the requirements of §A, of this regulation, are met. If the prescribing order exceeds 30 days, the therapist shall request a new order from the prescriber for continued therapy.