<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".02" citation="COMAR 10.38.03.02" title_num="10" subtitle_num="38" chapter_num="03" heading="Standards of Practice.">
  <paragraph num="A.">
    <text>Physical Therapists.</text>
    <paragraph num="(1)">
      <text>The physical therapist who establishes or changes the plan of care shall be ultimately responsible for patient care until another physical therapist:</text>
      <paragraph num="(a)">
        <text>Provides services to the patient; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Provides supervision to the treating physical therapist assistant.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The physical therapist shall:</text>
      <paragraph num="(a)">
        <text>Exercise sound professional judgment in the use of evaluation and treatment procedures;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Provide:</text>
        <paragraph num="(i)">
          <text>Physical therapy services to not more than an average of three patients per clinical treatment hour per calendar day, excluding group therapy; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Each patient with adequate treatment time consistent with accepted standards in delivering physical therapy care;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Provide the patient with accurate information about the physical therapy services provided;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Respect the right of the patient to refuse treatment;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Evaluate the patient and develop a plan of care before the patient is treated;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Work within the physical therapist's competency in physical therapy evaluation and treatment;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Reevaluate the patient as the patient's condition requires, but at least every 30 days, unless the physical therapist, consistent with accepted standards of physical therapy care, documents in the treatment record an appropriate rationale for not reevaluating the patient;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Provide direct supervision of students, aides, and individuals practicing under a temporary license;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Ascertain and periodically reevaluate the ability of students and aides to perform the assigned duties;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Delegate to the physical therapist assistant only treatment that is within the competency and scope of practice of the physical therapist assistant;</text>
      </paragraph>
      <paragraph num="(k)">
        <text>Provide direction and instruction for the physical therapist assistant that is adequate to ensure the safety and welfare of the patient; and</text>
      </paragraph>
      <paragraph num="(l)">
        <text>Document ongoing communication with the physical therapist assistant regarding changes in a patient's status and treatment plan.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>The physical therapist may:</text>
      <paragraph num="(a)">
        <text>Enter into an agreement or employment relationship provided that such agreement or relationship does not impede the physical therapist's exercise of independent judgment in the treatment of a patient or cause the physical therapist to practice physical therapy contrary to the Maryland Physical Therapy Act; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Decline to carry out evaluation or treatment of a patient who has been referred to the physical therapist by a health care practitioner if:</text>
        <paragraph num="(i)">
          <text>In the physical therapist's judgment, the evaluation or treatment is contraindicated or unjustified; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The physical therapist documents the decision in the patient's record.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Physical Therapist Assistants.</text>
    <paragraph num="(1)">
      <text>The physical therapist assistant shall:</text>
      <paragraph num="(a)">
        <text>Follow the direction and plan of care of the physical therapist in the treatment of a patient;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Exercise sound judgment and adequate care in the performance of duties;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Immediately discontinue any treatment procedure that appears to be harmful to the patient and so notify the supervising physical therapist;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Use only methods and procedures within the scope of the practice of limited physical therapy;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Respect the right of the patient to refuse treatment;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Work within the physical therapist assistant's competency in treatment that is within the scope of practice of limited physical therapy;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Document ongoing communication regarding changes in a patient's status and treatment authorized by the physical therapist; and</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Provide the following services:</text>
        <paragraph num="(i)">
          <text>Treat not more than an average of three patients per clinical treatment hour per calendar day, excluding group therapy; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Provide each patient with adequate treatment time consistent with accepted standards in physical therapy care.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The physical therapist assistant may:</text>
      <paragraph num="(a)">
        <text>Enter into an agreement or employment relationship provided that the agreement or relationship does not impede the physical therapist assistant's exercise of appropriate patient treatment or cause the physical therapist assistant to practice limited physical therapy in violation of the Maryland Physical Therapy Act; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Participate in the clinical education activities of a physical therapist assistant student if direct supervision of the student is provided by the physical therapist.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>The physical therapist assistant may not initiate treatment until:</text>
      <paragraph num="(a)">
        <text>The patient has been evaluated and the plan of care has been developed by a physical therapist; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A supervising physical therapist has been assigned to the physical therapist assistant.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>