<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".10" citation="COMAR 10.43.07.10" title_num="10" subtitle_num="43" chapter_num="07" heading="Activities That May Be Performed by Chiropractic Assistants Under Indirect Supervision of a Supervising Chiropractor.">
  <paragraph num="A.">
    <text>Indirect supervision may only be provided by a supervising chiropractor to a chiropractic assistant who is treating an established patient.</text>
  </paragraph>
  <paragraph num="B.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>Functional activities of daily living and hygiene;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Gait practice, ambulation, administration, and observation of therapeutic exercises as prescribed by a supervising chiropractor;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Assist in moving a patient within the treatment area;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Contrast baths;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Hot and cold packs;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Hubbard tank;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Infrared, ultraviolet irradiation, nonlaser light therapy, and nonablative therapeutic laser;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Muscle stimulation;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Electrotherapy;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Paraffin baths;</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Traction therapy;</text>
    </paragraph>
    <paragraph num="(12)">
      <text>Ultrasound;</text>
    </paragraph>
    <paragraph num="(13)">
      <text>Whirlpool;</text>
    </paragraph>
    <paragraph num="(14)">
      <text>Diathermy;</text>
    </paragraph>
    <paragraph num="(15)">
      <text>Therapeutic massage, if licensed under Health Occupations Article, Title 6, Annotated Code of Maryland; and</text>
    </paragraph>
    <paragraph num="(16)">
      <text>Mechanical or computerized examination procedures for the sole purpose of collecting data subject to the following conditions:</text>
      <paragraph num="(a)">
        <text>All data will later be used and interpreted by the chiropractor to form a diagnosis and treatment plan; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>No test may be performed that requires diagnosis or interpretation as part of the data collecting or testing procedure.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>A chiropractic assistant who participates in indirect supervision shall be:</text>
    <paragraph num="(1)">
      <text>In good standing with the Board; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Trained and proficient in the office’s indirect supervision protocol, which includes:</text>
      <paragraph num="(a)">
        <text>Informed consent to the patient; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Immediate access to the supervising chiropractor.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>The supervising chiropractor shall:</text>
    <paragraph num="(1)">
      <text>Prior to the implementation of indirect supervision, establish and make readily available an:</text>
      <paragraph num="(a)">
        <text>Emergency procedures protocol; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Indirect supervision protocol;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Maintain a log of indirect supervision treatment, which includes:</text>
      <paragraph num="(a)">
        <text>Patient’s name or identification information; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Treatment:</text>
        <paragraph num="(i)">
          <text>Date;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Time initiated;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Duration; and</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Procedure or activity provided; and</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Review or update, or both, indirect supervision orders every 30 days.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>An indirect supervision protocol shall be listed on the office’s:</text>
    <paragraph num="(1)">
      <text>Consent to treatment form signed by the patient; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Informed consent protocol.</text>
    </paragraph>
  </paragraph>
</regulation>