# COMAR Title 10 — Maryland Department of Health

## Subtitle 43 — Board of Chiropractic Examiners

### Chapter 07 — Chiropractic Assistants

#### Regulation .10 Activities That May Be Performed by Chiropractic Assistants Under Indirect Supervision of a Supervising Chiropractor.

*COMAR 10.43.07.10*

A. Indirect supervision may only be provided by a supervising chiropractor to a chiropractic assistant who is treating an established patient.

B. A chiropractic assistant may perform the following activities under the indirect supervision of a supervising chiropractor to an established patient with an established treatment program for not more than 10 percent of the treatment time in a given 30 days, without exceeding 3 consecutive days in a given week:

  (1) Functional activities of daily living and hygiene;

  (2) Gait practice, ambulation, administration, and observation of therapeutic exercises as prescribed by a supervising chiropractor;

  (3) Assist in moving a patient within the treatment area;

  (4) Contrast baths;

  (5) Hot and cold packs;

  (6) Hubbard tank;

  (7) Infrared, ultraviolet irradiation, nonlaser light therapy, and nonablative therapeutic laser;

  (8) Muscle stimulation;

  (9) Electrotherapy;

  (10) Paraffin baths;

  (11) Traction therapy;

  (12) Ultrasound;

  (13) Whirlpool;

  (14) Diathermy;

  (15) Therapeutic massage, if licensed under Health Occupations Article, Title 6, Annotated Code of Maryland; and

  (16) Mechanical or computerized examination procedures for the sole purpose of collecting data subject to the following conditions:

    (a) All data will later be used and interpreted by the chiropractor to form a diagnosis and treatment plan; and

    (b) No test may be performed that requires diagnosis or interpretation as part of the data collecting or testing procedure.

C. A chiropractic assistant who participates in indirect supervision shall be:

  (1) In good standing with the Board; and

  (2) Trained and proficient in the office’s indirect supervision protocol, which includes:

    (a) Informed consent to the patient; and

    (b) Immediate access to the supervising chiropractor.

D. The supervising chiropractor shall:

  (1) Prior to the implementation of indirect supervision, establish and make readily available an:

    (a) Emergency procedures protocol; and

    (b) Indirect supervision protocol;

  (2) Maintain a log of indirect supervision treatment, which includes:

    (a) Patient’s name or identification information; and

    (b) Treatment:

      (i) Date;

      (ii) Time initiated;

      (iii) Duration; and

      (iv) Procedure or activity provided; and

  (3) Review or update, or both, indirect supervision orders every 30 days.

E. An indirect supervision protocol shall be listed on the office’s:

  (1) Consent to treatment form signed by the patient; or

  (2) Informed consent protocol.