(a) Initiation of physical therapy services.
  (1) Referral requirement. Except as authorized by paragraph (2) of this subsection, a physical therapist is subject to discipline from the board for providing physical therapy treatment without a referral from a qualified healthcare practitioner licensed by the appropriate licensing board, who within the scope of the professional licensure is authorized to prescribe treatment of individuals. The list of qualifying referral sources includes physicians, dentists, chiropractors, podiatrists, physician assistants, and advanced nurse practitioners.
  (2) Exceptions to referral requirement.
    (A) A PT may evaluate without referral.
    (B) A PT may provide instructions to any person who is asymptomatic relating to the instructions being given without a referral, including instruction to promote health, wellness, and fitness.
    (C) Emergency Circumstances. A PT may provide emergency medical care to a person after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity without referral if the absence of immediate medical attention could reasonably be expected to result in a serious threat to the patient's health, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
    (D) A PT may treat a patient for an injury or condition without a referral for not more than 10 consecutive business days if the PT:
      (i) has been licensed to practice physical therapy for at least one year;
      (ii) is covered by professional liability insurance in the minimum amount of $100,000 per claim and $300,000 aggregate per year; and
      (iii) either:
        (I) possesses a doctoral degree in physical therapy from:
          (-a-) a program that is accredited by the Commission on Accreditation in Physical Therapy Education; or
          (-b-) an institution that is accredited by an agency or association recognized by the United States secretary of education; or
        (II) has completed at least 30 CCUs in the area of differential diagnosis.
    (E) A PT may treat a patient for an injury or condition without a referral for not more than 15 consecutive business days if the PT possesses a doctoral degree as described in subparagraph (D)(iii)(I)(-a-) or (-b-) of this paragraph and has satisfied the conditions set forth in subparagraph (D)(i) and (ii) of this paragraph, and either:
      (i) has completed a physical therapy residency or fellowship; or
      (ii) is certified by an entity approved by the board. The board will maintain a list of approved entities on its website.
    (F) A PT must obtain a referral from a qualified healthcare practitioner before continuation of treatment that exceeds that which is authorized in subparagraph (D) or (E) of this paragraph.
    (G) A PT who treats a patient without a referral under subparagraph (D) or (E) of this paragraph must obtain a signed disclosure on a form prescribed by the board prior to the initiation of treatment. The disclosure form will be made available on the board's website.
  (3) Methods of referral. A referral may be transmitted by a qualifying referral source in the following ways:
    (A) in a written document, including faxed and emailed documents; or
    (B) verbally, in person or by telephone. If a referral is transmitted verbally, whether in person or by telephone, it must be received, recorded and signed by the PT, PTA or other authorized personnel, and include all of the information that would appear on a written referral.
(b) Evaluation and screening.
  (1) Evaluation. Physical therapy treatment may not be provided prior to the completion of an evaluation of the patient's condition by a PT.
  (2) PTAs may screen patients designated by a PT as possible candidates for physical therapy services. Screening entails the collection of uniform information from all patients screened using a predetermined, standardized format. The information collected is delivered to the supervising PT. Only a PT may determine whether further intervention for patients screened is necessary.
(c) Physical therapy plan of care development and implementation.
  (1) The PT must develop a written plan of care, based on his evaluation, for each patient.
  (2) Treatment may not be provided by a PTA or aide until the plan of care has been established.
  (3) The plan of care must be reviewed and updated as necessary following a reevaluation of the patient's condition.
  (4) The plan of care or treatment goals may only be changed or modified by a PT.
  (5) A PTA may modify treatment techniques as indicated in the plan of care.
  (6) A PT or PTA must interact with the patient regarding his/her condition, progress and/or achievement of goals during each treatment session.
(d) Reevaluation.
  (1) Provision of physical therapy treatment by a PTA or an aide may not continue if the PT has not performed a reevaluation:
    (A) at a minimum of once every 60 days after treatment is initiated, or at a higher frequency as established by the PT; and
    (B) In response to a change in the patient's medical status that affects physical therapy treatment, when a change in the physical therapy plan of care is needed, or prior to any planned discharge.
  (2) A reevaluation must include:
    (A) Direct physical therapist-to-patient interaction; and
    (B) A review of the plan of care with appropriate continuation, revision, or termination of treatment.
(e) Documentation of treatment.
  (1) At a minimum, documentation of physical therapy services must include the following:
    (A) any referral authorizing treatment;
    (B) the initial examination and evaluation;
    (C) the plan of care;
    (D) documentation of each treatment session by the PT or PTA providing the services;
    (E) reevaluations as required by this section;
    (F) any conferences between the PT and PTA, as described in this section; and
    (G) the discharge summary.
  (2) The PTA must include the name of the supervising PT in his documentation of each treatment session.
  (3) Physical therapy aides may not write or sign any physical therapy documents in the permanent record. However, a physical therapy aide may enter quantitative data for tasks delegated by the supervising PT or PTA.
  (4) Discharge Summary. The PT must provide final documentation for discharge of a patient, including patient response to treatment at the time of discharge and any necessary follow-up plan. A PTA may participate in the discharge summary by providing subjective and objective patient information to the supervising physical therapist.

Source Note: The provisions of this §322.1 adopted to be effective April 15, 1999, 24 TexReg 2935; amended to be effective November 19, 2001, 26 TexReg 9382; amended to be effective September 18, 2006, 31 TexReg 7998; amended to be effective February 18, 2008, 33 TexReg 1335; amended to be effective April 4, 2011, 36 TexReg 2124; amended to be effective March 1, 2015, 40 TexReg 704; amended to be effective September 4, 2016, 41 TexReg 6497; amended to be effective November 1, 2019, 44 TexReg 6369; amended to be effective November 1, 2021, 46 TexReg 7213