# COMAR Title 10 — Maryland Department of Health

## Subtitle 38 — Board of Physical Therapy Examiners

### Chapter 03 — Standards of Practice

**Authority:** Health Occupations Article, §§13-206, 13-309, and 13-310, Annotated Code of Maryland

**Administrative History:** Effective date: August 2, 1982 (9:15 Md. R. 1515)

**Administrative History:** Regulation .01B amended effective January 20, 1991 (19:1 Md. R. 33); December 19, 1994 (21:25 Md. R. 2106); April 16, 2001 (28:7 Md. R. 690); March 18, 2002 (29:5 Md. R. 504); March 31, 2003 (30:6 Md. R. 421); April 24, 2006 (33:8 Md. R. 734)

**Administrative History:** Regulation .02 amended effective December 19, 1994 (21:25 Md. R. 2106)

**Administrative History:** Regulation .02 repealed and new Regulation .02 adopted effective March 18, 2002 (29:5 Md. R. 504)

**Administrative History:** Regulation .02 amended effective March 31, 2003 (30:6 Md. R. 421)

**Administrative History:** Regulation .02A amended as an emergency provision effective May 23, 2002 (29:12 Md. R. 924; amended permanently effective September 2, 2002 (29:17 Md. R. 1381)

**Administrative History:** Regulation .02A amended effective April 24, 2006 (33:8 Md. R. 734); February 25, 2008 (35:4 Md. R. 515); April 4, 2022 (49:7 Md. R. 466)

**Administrative History:** Regulation .02R amended effective January 1, 1996 (22:26 Md. R. 2030)

**Administrative History:** Regulation .02-1 adopted effective January 20, 1992 (19:1 Md. R. 33)

**Administrative History:** Regulation .02-1B amended effective December 19, 1994 (21:25 Md. R. 2106)

**Administrative History:** Regulation .02-1 repealed and new Regulation .02-1 adopted effective March 18, 2002 (29:5 Md. R. 504)

**Administrative History:** Regulation .02-1 amended effective April 24, 2006 (33:8 Md. R. 734)

**Administrative History:** Regulation .03 amended effective December 19, 1994 (21:25 Md. R. 2106)

#### Regulation .01 Definitions.

*COMAR 10.38.03.01*

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

  (1) “Board” means the Board of Physical Therapy Examiners of Maryland created by Health Occupations Article, §13-201, Annotated Code of Maryland.

  (2) “Clinical treatment hour” means an hour in which physical therapy or limited physical therapy services are provided at some point during the hour.

  (3) “Electronically signed” means an electronic sound, symbol, or process attached to or logically associated with a record and executed or adopted by a person with the intent to sign the record.

  (4) “Evaluations” means procedures which include, but are not limited to:

    (a) Testing of strength, sensation, and reflexes;

    (b) Goniometric measurements and their interpretation;

    (c) Assessments of function, muscle tone, developmental levels, accessory motions, posture, and pain scale.

  (5) “Goals” means the expected outcome as the result of therapy.

  (6) “Group therapy” means treatment procedures provided simultaneously to two or more patients that:

    (a) Require constant attendance, but not one-on-one contact by the physical therapist or physical therapist assistant; and

    (b) Can be, but need not be, the same treatment procedures.

  (7) "History" means data that is pertinent to the current physical therapy problem.

  (8) “Hour” means a 60-minute increment during a calendar day which is calculated by dividing the day into consecutive 60-minute increments beginning when the day's first physical therapy or limited physical therapy service starts and ending when the last physical therapy or limited physical therapy service terminates, the last consecutive increment of which may be a fraction of an hour.

  (9) “Interpretation” means the analysis of findings for the purpose of establishing and justifying the plan of care.

  (10) “License number” means the Maryland physical therapy license number issued by the Board.

  (11) “Onset” means the date of occurrence of the condition for which physical therapy is being provided.

  (12) “Physical therapy diagnosis” means the condition for which physical therapy is provided if different from the medical diagnosis.

  (13) “Plan of care” means the plan of treatment aimed at achieving the anticipated functional goals.

  (14) “Progress” means the measurable improvement as related to goals.

  (15) “Reevaluation” means a measurement of progress, or lack of it, based on comparisons of tests, measurements, and assessments with previous evaluation or reevaluations.

  (16) “Requirements for documentation” means the requirements as set forth in Regulation .02-1 of this chapter and approved by the Board.

  (17) “Response to treatment” means a brief statement of the patient's condition at conclusion of treatment.

  (18) “Services” means the evaluation or treatment, or both, as appropriate, of a patient.

  (19) “Signature and title” means the name of the physical therapist or physical therapist assistant written by that person or electronically signed by that person in accordance with federal and State law and followed by the title “PT” or “PTA” and license number. A stamp of a signature is not acceptable as a signature for documentation.

  (20) “Student” means an individual who is currently enrolled in a physical therapy or physical therapist assistant educational program approved by the Board.

  (21) “Supervising physical therapist” means a physical therapist who provides ongoing supervision to a physical therapist assistant regarding the care of a patient.

  (22) “Supportive personnel” includes aides and other unlicensed personnel.

  (23) “Test results” means the measurable and objective findings obtained from the evaluations.

#### Regulation .02 Standards of Practice.

*COMAR 10.38.03.02*

A. Physical Therapists.

  (1) The physical therapist who establishes or changes the plan of care shall be ultimately responsible for patient care until another physical therapist:

    (a) Provides services to the patient; or

    (b) Provides supervision to the treating physical therapist assistant.

  (2) The physical therapist shall:

    (a) Exercise sound professional judgment in the use of evaluation and treatment procedures;

    (b) Provide:

      (i) Physical therapy services to not more than an average of three patients per clinical treatment hour per calendar day, excluding group therapy; and

      (ii) Each patient with adequate treatment time consistent with accepted standards in delivering physical therapy care;

    (c) Provide the patient with accurate information about the physical therapy services provided;

    (d) Respect the right of the patient to refuse treatment;

    (e) Evaluate the patient and develop a plan of care before the patient is treated;

    (f) Work within the physical therapist's competency in physical therapy evaluation and treatment;

    (g) 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;

    (h) Provide direct supervision of students, aides, and individuals practicing under a temporary license;

    (i) Ascertain and periodically reevaluate the ability of students and aides to perform the assigned duties;

    (j) Delegate to the physical therapist assistant only treatment that is within the competency and scope of practice of the physical therapist assistant;

    (k) Provide direction and instruction for the physical therapist assistant that is adequate to ensure the safety and welfare of the patient; and

    (l) Document ongoing communication with the physical therapist assistant regarding changes in a patient's status and treatment plan.

  (3) The physical therapist may:

    (a) 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

    (b) Decline to carry out evaluation or treatment of a patient who has been referred to the physical therapist by a health care practitioner if:

      (i) In the physical therapist's judgment, the evaluation or treatment is contraindicated or unjustified; and

      (ii) The physical therapist documents the decision in the patient's record.

B. Physical Therapist Assistants.

  (1) The physical therapist assistant shall:

    (a) Follow the direction and plan of care of the physical therapist in the treatment of a patient;

    (b) Exercise sound judgment and adequate care in the performance of duties;

    (c) Immediately discontinue any treatment procedure that appears to be harmful to the patient and so notify the supervising physical therapist;

    (d) Use only methods and procedures within the scope of the practice of limited physical therapy;

    (e) Respect the right of the patient to refuse treatment;

    (f) Work within the physical therapist assistant's competency in treatment that is within the scope of practice of limited physical therapy;

    (g) Document ongoing communication regarding changes in a patient's status and treatment authorized by the physical therapist; and

    (h) Provide the following services:

      (i) Treat not more than an average of three patients per clinical treatment hour per calendar day, excluding group therapy; and

      (ii) Provide each patient with adequate treatment time consistent with accepted standards in physical therapy care.

  (2) The physical therapist assistant may:

    (a) 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

    (b) Participate in the clinical education activities of a physical therapist assistant student if direct supervision of the student is provided by the physical therapist.

  (3) The physical therapist assistant may not initiate treatment until:

    (a) The patient has been evaluated and the plan of care has been developed by a physical therapist; and

    (b) A supervising physical therapist has been assigned to the physical therapist assistant.

#### Regulation .02-1 Requirements for Documentation.

*COMAR 10.38.03.02-1*

A. The physical therapist shall document legibly the patient's chart each time the patient is seen for:

  (1) The initial visit, by including the following information:

    (a) Date;

    (b) Condition, or diagnosis, or both, for which physical therapy is being rendered;

    (c) Onset;

    (d) History, if not previously recorded;

    (e) Evaluation and results of tests (measurable and objective data);

    (f) Interpretation;

    (g) Goals;

    (h) Modalities, or procedures, or both, used during the initial visit and the parameters involved including the areas of the body treated;

    (i) Plan of care including suggested modalities, or procedures, or both, number of visits per week, and number of weeks; and

    (j) Signature, title (PT), and license number.

  (2) Subsequent visits, by including the following information (progress notes):

    (a) Date;

    (b) Cancellations, no-shows;

    (c) Modalities, or procedures, or both, with any changes in the parameters involved and areas of body treated;

    (d) Objective status;

    (e) Response to current treatment, if any;

    (f) Changes in plan of care; and

    (g) Signature, title (PT), and license number, although the flow chart may be initialed.

  (3) Reevaluation, by including the following information in the report, which may be in combination with the visit note, if treated during the same visit:

    (a) Date;

    (b) Number of treatments since the initial evaluation or last reevaluation;

    (c) Reevaluation, tests, and measurements of areas of body treated;

    (d) Changes from previous objective findings;

    (e) Interpretation of results;

    (f) Goals met or not met and reasons;

    (g) Updated goals;

    (h) Updated plan of care including recommendations for follow-up; and

    (i) Signature, title (PT), and license number;

  (4) Discharge, by including the following information in the discharge summary, which may be combined with the final visit note, if seen by the physical therapist on the final visit and written by the physical therapist:

    (a) Date;

    (b) Reason for discharge;

    (c) Objective status;

    (d) Recommendations for follow-up; and

    (e) Signature, title (PT), and license number.

B. Notwithstanding §A(4) of this regulation, a physical therapist may direct a physical therapist assistant to treat a patient on a final visit.

C. The physical therapist assistant shall document the patient's chart each time the patient is seen by the physical therapist assistant following the physical therapist's initial evaluation or reevaluation by including the following:

  (1) Date;

  (2) Cancellations and no-shows;

  (3) Modalities, procedures, or both, including parameters involved, and areas of body treated;

  (4) Objective status;

  (5) Response to treatment, if any;

  (6) Continuation of plan as established by the physical therapist or change of plan as authorized by the physical therapist; and

  (7) Signature, title (PTA), and license number, although the flow chart may be initialed.

D. Subsequent visits, as referred to in §A(2) of this regulation, in the same day by the same physical therapist do not require separate progress notes unless there is a change in the patient's status.

E. Ongoing Communications. Both the physical therapist and the physical therapist assistant shall document ongoing communication between the physical therapist and physical therapist assistant regarding changes in a patient's status and treatment plan.

#### Regulation .03 Penalties.

*COMAR 10.38.03.03*

Violation of these regulations may result in the Board taking action to reprimand a licensee, place a licensee on probation, or suspend or revoke a license. The Board may also impose a penalty not exceeding $5,000.