Georgia PT Ethics and Jurisprudence

Georgia PT Ethics and Jurisprudence Course Description: Georgia PT Ethics and Jurisprudence was designed to help therapy professionals with the ethical dilemmas they face in the workplace. The course is designed to promote a better understanding of ethics, morals and legal behavior in the hopes of facilitating a better decision making process for professionals in ethical situations. The course also incorporates the rules and laws governing physical therapy in the state of Georgia specifically Georgia Rules 490-1 through 490-12 and Georgia Laws 43-33 and Georgia General Provisions 43-1-9 and 43-1-19 through 43-1-27. It also covers the Georgia Board Policies and Rules. It incorporates a general Georgia Board of PT website review and FAQs and an aptitude website review along with a review of any proposed rules on the board website. Lastly case studies are provided to help identify appropriate ethical responses/actions to specific situations. Course Author: Mary Smith, RPT Methods of Instruction: Online course available via internet Target Audience: Physical Therapists and Physical Therapist Assistants Educational Level: Intermediate Prerequisites: None Course Goals and Objectives: At the completion of this course, participants should be able to: 1. Define Ethics 2. Define Morality 3. Identify the basic similarities and differences between ethics and morals 4. Differentiate between common ethical theories 5. Define determinants of moral and ethical behavior 6. Understand the ethical decision-making process 7. Identify and understand the rules and laws governing physical therapy in the state of Georgia specifically Georgia Rules 490-1 through 490-12 and Georgia Laws 43-33 and Georgia General Provisions 43-1-9 and 43-1-19 through 43-1-27. 8. Understand and apply the Georgia State Board of Physical Therapy Board Policies and Rules 9. Identify the key components on the Georgia Board of PT website and FAQs 10. Identify the key components and operating procedures of the aptitude website 11. Identify any proposed rules on the Georgia Board of PT website 12. Understand and apply ethical case studies 1 of 85

Criteria for Obtaining Continuing Education Credits: A score of 70% or greater on the post-test 2 of 85

DIRECTIONS FOR COMPLETING THE COURSE: 1. Review the goals and objectives for the course. 2. Review the course material. 3. We strongly suggest printing out a hard copy of the test. Mark your answers as you go along and then transfer them to the actual test. A printable test can be found when clicking on View/Take Test in your My Account. 4. After reading the course material, when you are ready to take the test, go back to your My Account and click on View/Take Test. 5. A grade of 70% or higher on the test is considered passing. If you have not scored 70% or higher, this indicates that the material was not fully comprehended. To obtain your completion certificate, please re-read the material and take the test again. 6. After passing the test, you will be required to fill out a short survey. After the survey, your certificate of completion will immediately appear. We suggest that you save a copy of your certificate to your computer and print a hard copy for your records. 7. You have up to one year to complete this course from the date of purchase. 8. If we can help in any way, please don t hesitate to contact us utilizing our live chat, via email at info@advantageceus.com or by phone at 405-974-0164. 3 of 85

Georgia PT Ethics and Jurisprudence Physical therapy should be black and white right? You go to school, learn how to be a great therapist, graduate with the degree and then rush out to help the world. And usually, it works out that way and both patients and therapists win. But more and more these days, well intentioned physical therapists are running into situations where the lines between right and wrong blur.where situations aren t always black and white.where ethics plays a vital role. As physical therapists become more autonomous in their role as healthcare providers, ethical situations are more likely to arise. This course is designed to educate therapists about ethics, to help them make good ethical decisions and feel confident about those decisions. What IS Ethics?? To understand better the concepts of physical therapy ethics, it is good first to have an overview of the discipline of ethics. The word ethics is coined from the Greek word ethos which means character and from the Latin word mores which means customs. Together, they combine and define how individuals make a choice of interacting with one another. In the field of physical therapy, the study of ethics is categorized into normative or philosophical ethics and social scientific or descriptive ethics. Philosophical ethics mainly deals with what people are supposed to do and how they should carry themselves as well as the rationality in making such decisions. Social scientific ethics on the other hand focuses on the study of human ethical behavior with empirical or social scientific tools aiming at exploring the bases of human objectives and the bases of right and wrong human deeds that enhance or hinder these goals. The significance of ethics is evidential on several levels. First, when people work in an ethical manner, they feel better about their profession and themselves. Second, ethics builds public trust which increases credibility of professions. Third, ethics promotes business at the organizational level. Businesses that are run ethically perform better than those run in an unethical manner. 4 of 85

Breaking down the basic definitions. The Definition of Ethics A set of principles designed to determine right or wrong conduct. A theory or a system of moral values. The study of the general nature of morals and of the specific moral choices to be made by a person; moral philosophy. The rules or standards governing the conduct of a person or the members of a profession. The Definition of Moral Being concerned with principles of right and wrong or conforming to standards of behavior and character based on those principles There are several sub-types of morality. Types of Morality Personal: values and duties you adopt as relevant In its first, descriptive usage, morality means a code of conduct which is held to be authoritative in matters of right and wrong. Morals are created and defined by society, philosophy, religion, or individual conscience. An example of the descriptive usage could be "common conceptions of morality have changed significantly over time." Societal: common denominator of shared beliefs In its second, normative and universal sense, morality refers to an ideal code of conduct, one which would be espoused in preference to alternatives by all rational people, under specified conditions. In this "prescriptive" sense of morality as opposed to the above described "descriptive" sort of sense, moral value judgments such as "murder is immoral" are made. To deny 'morality' in this sense is a position known as moral skepticism, in which the existence of objective moral "truths" is rejected. 5 of 85

Group: shared by the group you belong to such as work, religious, social and professional groups In its third usage, 'morality' is synonymous with ethics. When confronted with an ethical distress or dilemma that needs a decision, there are really three levels in which an ethical decision needs to be made. 1. An ethical problem is one in which the practitioner is confronted by challenges or threats to his or her moral duties and values. 2. Ethical distress occurs when practitioners know the course of action they should take, but for whatever reason, they do not take it. They may be blocked from being the kind of person that they want to be and cannot do the things that they really want to do or they feel is right. There may be institutional or financial barriers. 3. An ethical dilemma is when there are two morally correct courses of action, but they cannot both be followed at the same time. Ethics versus Morals People often confuse the words ethics and morals sometimes using them interchangeably. Notably though, the two words are not identical. The term morals refer to practices whereas ethics usually refers to the rationale that support or oppose such practices. In short, morals are concerned with actions and ethics with reasoning behind such actions. Ethics is usually at a higher intellectual level, more universal, and more emotionally involved than morals. From time immemorial, man has tried to come up with philosophical bases for determining what is wrong or right. With this several ethical theories have been proposed. Some of generally accepted ethical theories are utilitarianism, social contract theory, deontological theory, ethical intuitionism, ethical egoism, and natural law theory and virtue ethics. Utilitarianism is the idea that the moral worth of an action is determined only by what it can contribute to overall utility. Its worth is its contribution to happiness as summed among all people. It is a form of consequentialism, meaning that the moral worth of an action is determined by its outcome. Utilitarianism is sometimes described by the phrase "the greatest good for the greatest number of people". It is commonly known as "the greatest happiness principle". 6 of 85

Social contract describes a group of theories that explains how people maintain social order. This theory states that some individuals give up their rights to authority in order for society to maintain a higher and more organized social order. Deontological theory states that all acts are either inherently good or bad, no matter what the end result is. Most deontological theorists believe that we have a duty to do what is inherently good, even if the end result or consequence is bad. Ethical Intuitionism is described as common sense or conscience. It states that an act or decision is ruled as right or wrong depending upon the natural intuition of the individual. Ethical Egoism operates under the idea that each individual must make decisions based on what is in their own best interests. Natural law theory is a philosophical and legal belief that all humans are governed by basic innate laws, or laws of nature, which are separate and distinct from laws which are legislated. It infers that natural law is akin to common sense or intuition. Virtue ethics may be identified as the one that emphasizes the virtues, or moral character, in contrast to the other theories that emphasizes duties or rules. This theory points to how the decision could be good, charitable or benevolent. Determinants of Ethical/Moral Behavior There are basically four components to moral behavior - moral sensitivity, moral judgment, moral motivation and moral character. For a good ethical decision to be made, all four of these components have to be in place. None is more important than the other. All four of them have to be in place to meet the requirement of an ethical decision. 1. Moral Sensitivity Moral sensitivity is the ability to interpret the situation and project the consequences of your actions. If you do not have moral sensitivity, then you do not act ethically because it does not occur that what you are doing is going to affect anybody else. 7 of 85

2. Moral Judgment Moral judgment is deciding which action is right or wrong because you are able to assess how the different lines of actions that you could take will affect other people. 3. Moral Motivation Moral motivation prioritizes moral values over motives such as self gratification, making money, revenge, protecting your reputation or protecting your organization. 4. Moral Character This is the ability to have the perseverance, the toughness, the conviction and the courage to take action to correct something that you know is wrong. This is taking on the duty to report even if you are not required to report. It is truly the essence of professional behavior. This is the standard that we need to achieve. We need to help people understand that it is their responsibility to stop actions that might be negative for the people that they treat and for the community that we serve. 5. Moral Failure Moral failure occurs when any of these components do not happen. In order to take moral action, you have to have all four of them. It is a complex interaction. Now that we understand all of the terminology and basic theories, we come down to a more important question. There are so many theories and rules HOW do I go about making the right ethical decision in my every day practice??? The Ethical Decision-Making Process: When making ethical decisions, we need to remember the 6 Ethical principles, as they could and SHOULD direct our decisions. (1) Autonomy: patients have the right to make some decisions as well as we do. (2) (3) (4) Beneficence: providing care in the best interest of the patient Confidentiality: respecting an individual s right to privacy Non malfeasance: do no harm 8 of 85

(5) Justice: equity or fair treatment (6) Veracity: truthfulness It is also important that an individual be able to answer the following questions. (1) Test for Right versus Wrong- is it obvious? (2) Legal test: Is it legal? (3) PU test: Does it smell or feel wrong-a test of common sense/conscience (4) Front page test: How would it look on the front page of the newspaper? Would that make you change your decision or how you feel about the situation? (5) Mom/Dad Test: How would your parents feel if they knew what you were doing? (6) The professional ethics test: What do the Code of Ethics, Standards of Ethical Conduct say? Know your practice act and rules and regulations. Be active in your professional organization. Realize that at times, rules and regulations change! Make sure you stay updated at all times. Georgia Physical Therapy Practice Act Official Code 43-33 Title 43. Professions and Businesses Chapter 33. Physical Therapists 43-33-1. Short title This chapter shall be known and may be cited as the "Georgia Physical Therapy Act." 43-33-2. Declaration of purpose This chapter is enacted for the purpose of safeguarding the public health, safety, and welfare by providing for state administrative control, supervision, and regulation of the practice of physical therapy. The practice of physical 9 of 85

therapy is declared to be affected with the public interest; and this chapter shall be liberally construed so as to accomplish the purpose stated in this Code section. 43-33-3. Definitions As used in this chapter, the term: (1) "Board" means the State Board of Physical Therapy. (2) "License" means a valid and current certificate of registration issued by the board, which shall give the person to whom it is issued authority to engage in the practice prescribed thereon. (3) "Licensee" means any person holding a license under this chapter. (4) "Person" means a human being only, not a legal entity. (5) "Physical therapist" means a person licensed to practice physical therapy as defined in this chapter and whose license is in good standing. (6) "Physical therapist assistant" or "physical therapy assistant" means a person who is licensed by the board to assist a physical therapist, whose activities are supervised and directed by a physical therapist, and whose license is in good standing. (7) "Physical therapy" means the care and services provided by or under the direction and supervision of a physical therapist who is licensed pursuant to this chapter. The term physiotherapist shall be synonymous with physical therapy pursuant to this chapter. The practice of physical therapy means: (A) Examining, evaluating, and testing patients and clients with mechanical, physiological, and developmental impairments, activity limitations, participation restrictions, and disabilities or other movement related conditions in order to determine a physical therapy diagnosis, prognosis, and plan of intervention and to assess the ongoing effects of intervention; (B) Alleviating impairments of body structure or function by designing, implementing, and modifying interventions to improve activity limitations or participation restrictions for the purpose of preventing or reducing the incidence and severity of physical disability, bodily malfunction, and pain; 10 of 85

(C) Reducing the risk of injury, impairment, activity limitations, participation restrictions, and disability, including the promotion and maintenance of health, fitness, and wellness in populations of all ages; (D) Planning, administering, evaluating, and modifying intervention and instruction, including the use of physical measures, activities, and devices, including but not limited to dry needling for preventative and therapeutic purposes; and (E) Engaging in administration, consultation, education, teaching, research, telehealth, and the provision of instructional, consultative, educational, and other advisory services. (8) "Physical therapy aide" means a person who only performs designated and supervised physical therapy tasks. The physical therapy aide must receive direct supervision and must be directed on the premises at all times by a licensee. Physical therapy aides are not licensed under this chapter. (9) "Trainee" means an individual who is approved for a traineeship. (10) "Traineeship" means a period of activity during which a trainee works under the direct supervision of a licensed physical therapist who has practiced for not less than one year prior to assuming the supervisory role. (11) "Training permit" means a valid and current certificate of registration issued by the board, which gives the person to whom it is issued authority to engage in practice through a traineeship prescribed thereon. 43-33-4. Creation of board There is created a State Board of Physical Therapy. 43-33-5. Appointment of board members; terms; vacancies; removal The board shall consist of eight members, as provided in Code Section 43-33-6, each of whom shall be appointed by the Governor and confirmed by the Senate for a term of three years and until a successor is appointed and qualified. Vacancies on the board shall be filled by the Governor's appointment of a successor to serve out the unexpired term. The Governor, after notice and opportunity for hearing, may remove any member of the board for neglect of duty, incompetence, revocation or suspension of license of those licensee members, or other dishonorable conduct. No person shall serve consecutively more than two full terms as a member of the board. 11 of 85

43-33-6. Qualifications of board members To be eligible for appointment to the board, a person must be a resident of this state. Six members of the board shall be licensed as physical therapists under this chapter who have practiced or taught physical therapy for at least three years. At least one member shall be licensed and practicing as a physical therapist assistant for at least three years. The eighth member shall be appointed from the public at large and shall have no business connection whatsoever with the practice or profession of physical therapy. 43-33-7. Conduct of business by telephone With the exception of hearings in contested cases, the board may conduct business in conference by telephone, provided that members of the board shall not receive compensation for business conducted in conference by telephone or other digital means. 43-33-8. Reimbursement of board members Each member of the board shall be reimbursed as provided for in subsection (f) of Code Section 43-1-2. 43-33-9. Division director as secretary of board; subpoena power; service of process and documents; official records as prima- facie evidence The division director shall be secretary of the board and shall perform such other administrative duties as may be prescribed by the board. In a contested case, the division director on behalf of the board shall have the power to subpoena, throughout the state, witnesses, designated documents, papers, books, accounts, letters, photographs, objects, or other tangible things. All legal process and all documents required by law to be served upon or filed with the board shall be served upon or filed with the division director at his or her office in Atlanta. All official records of the board or affidavits by the division director certifying the content of such records shall be prima- facie evidence of all matters required to be kept therein. 43-33-10. General powers and duties of board In carrying out the provisions of this chapter, the board shall, in addition to the other powers conferred upon it under this chapter, have the power to: (1) Prepare or approve all examinations or applicants for licenses; (2) Determine the qualifications of and authorize the issuance of licenses to qualified physical therapists and physical therapist assistants; 12 of 85

(3) Determine the qualifications for and approve educational programs that prepare physical therapists and physical therapist assistants for the purpose of determining qualifications of applicants for licensure; (4) Initiate investigations of alleged or suspected violations of the provisions of this chapter or other laws of this state pertaining to physical therapy and any rules and regulations adopted by the board. For this purpose, any board member or authorized agent of the board shall have the power and right to enter and make reasonable inspection of any place where physical therapy is practiced; (5) Conduct all hearings in contested cases according to Chapter 13 of Title 50, known as the "Georgia Administrative Procedure Act"; (6) Discipline any person licensed under this chapter, or refuse to grant, renew, or restore a license to any person upon any ground specified in this chapter; (7) Adopt a seal, the imprint of which together with the authorized signature of either the division director or other member authorized by the board shall be effective to evidence its official acts; (8) Establish licensing fees and maintain in the office of the division director a register of all persons holding a license and a record of all inspections made; (9) Adopt and publish a code of ethics; (10) Issue training permits; and (11) Adopt such rules and regulations as shall be reasonably necessary for the enforcement and implementation of the provisions and purposes of this chapter and other laws of this state insofar as they relate to physical therapy. 43-33-11. License required for physical therapists or physical therapist assistants; use of titles; limitation on scope of Code section (a) A physical therapist shall clearly inform the public of his or her professional credential as a physical therapist. A physical therapist shall use the appropriate regulatory designator as identified by the board. (b) A physical therapist assistant shall use the letters 'PTA' immediately following his or her name to designate licensure under this chapter. A person shall not use the title 'physical therapist assistant,' the letters 'PTA,' or any 13 of 85

other words, abbreviations, or insignia in connection with that person's name to indicate or imply, directly or indirectly, that the person is a physical therapist assistant unless that person is licensed as a physical therapist assistant pursuant to this chapter. (c) A person or business entity and its employees, agents, or representatives shall not use in connection with that person's name or the name or activity of the business entity the words 'physical therapy,' 'physical therapist,' 'physiotherapist,' or 'doctor of physical therapy,' the letters 'PT,' 'CPT,' 'DPT,' 'LPT,' 'RPT,' or 'MPT,' or any other words, abbreviations, or insignia indicating or implying, directly or indirectly, that physical therapy is provided or supplied, unless such services are provided by or under the direction of a physical therapist licensed pursuant to this chapter. A person or business entity shall not advertise or otherwise promote another person as being a physical therapist or physiotherapist unless the individual so advertised or promoted is licensed as a physical therapist under this chapter. A person or business entity that offers, provides, or bills any other person for services shall not characterize those services as physical therapy unless the individual directing and supervising those services is a person licensed under this chapter. (d)nothing in this Code section shall be construed as preventing or restricting the practice, services, or activities of: (1) Any person licensed under any other law of this state who is engaged in the professional or trade practices properly conducted under the authority of such other licensing laws; (2) Any person pursuing a course of study leading to a degree or certificate as a physical therapist or as a physical therapist assistant in an entry level educational program approved by the board, if such person is designated by a title indicating student status, is fulfilling work experiences required for the attainment of the degree or certificate, and is under the supervision of a licensed physical therapist; (3) Any person enrolled in a course of study designed to develop advanced physical therapy skills when the physical therapy activities are required as part of an educational program sponsored by an educational institution approved by the board and are conducted under the supervision of a physical therapist licensed under this chapter. If such person provides physical therapy services outside the scope of the educational program, he or she shall then be required to be licensed in accordance with this chapter; 14 of 85

(4) A physical therapist licensed in another state or country or employed by the United States government conducting a teaching or clinical demonstration in connection with an academic or continuing education program; (5) Any person employed as a physical therapist or as a physical therapist assistant by the United States government if such person provides physical therapy services solely under the direction or control of the employing organization. If such person shall engage in the practice of physical therapy or as a physical therapist assistant outside the course and scope of such employment, he or she shall then be required to be licensed in accordance with this chapter; or (6) A person currently licensed in another state who is present in this state for treatment of a temporary sojourner only, said treatment in this state not to exceed a total of 60 days during any 12 month period. (7) A person currently licensed in another state who is present in this state providing physical therapy services during a declared local, jurisdictional, or natural disaster or emergency, such services not to exceed a total of 60 days during any 12 month period. 43-33-12. Requirements for license to practice physical therapy A license to practice physical therapy shall be issued to any person who: (1) Is a graduate of an educational program that prepares physical therapists and which is accredited by a recognized accrediting agency and approved by the board or, in the case of an applicant who has graduated from an educational program which prepares physical therapists conducted in a foreign country, has submitted, in a manner prescribed by the board, credentials approved by the board and who has further demonstrated the ability to speak, write, and understand the English language and has satisfactorily completed a three- month board approved traineeship under the supervision of a physical therapist licensed under this chapter; (2) Has satisfactorily passed an examination prepared or approved by the board; and (3) Is not disqualified to receive a license under the provisions of Code Section 43-33-18 or subsection (a) of Code Section 43-1-19. 15 of 85

43-33-13. Requirements for license to practice as physical therapist assistant A license to practice as a physical therapist assistant shall be issued to any person who: (1) Is a graduate of an educational program that prepares physical therapist assistants and which is accredited by a recognized accrediting agency and approved by the board or, in the case of an applicant who has graduated from an educational program which prepares physical therapist assistants conducted in a foreign country, has submitted, in a manner prescribed by the board, credentials approved by the board and who has further demonstrated the ability to speak, write, and understand the English language and has satisfactorily completed a three- month board approved traineeship under the supervision of a physical therapist licensed under this chapter; (2) Has satisfactorily passed an examination prepared or approved by the board; and (3) Is not disqualified to receive a license under the provisions of Code Section 43-33-18 or subsection (a) of Code Section 43-1-19. 43-33-13.1. Physical therapy aide A physical therapy aide is one, other than a physical therapist or physical therapist assistant, who is employed to assist a physical therapist or a physical therapist assistant by performing only designated physical therapy tasks under direct supervision of a licensee as approved by the board by rule or regulation. 43-33-14. Determining competence of applicants The board shall determine the competence of applicants to practice as physical therapists or as physical therapist assistants by any method or procedure which the board deems necessary to test the applicant's qualifications. 43-33-15. Reciprocity; waiver of examination requirement for persons licensed in another state who meet certain qualifications The board may, in its discretion, waive the examination provided for in paragraph (2) of Code Section 43-33-12 and may, subject to the provisions under Code Sections 43-33- 18 and 43-33-19, grant to a person licensed in another state or territory of the United States full privileges to engage in an equivalent practice authorized by this chapter to any person who has qualifications the board determines to be the substantial equivalent of the 16 of 85

qualifications described under paragraph (1) of Code Section 43-33-12 and who is properly licensed under the laws of another state or territory of the United States; provided, however, that the license held by such person was issued after an examination which, in the judgment of the board, is the equivalent of the standards established by the board. In waiving the examination requirement, the board may require additional education or training 43-33-16. Expiration, renewal, and restoration of licenses; canceled licenses; continuing education All licenses shall expire biennially unless renewed. All applications for renewal of a license shall be filed with the division director prior to the expiration date, accompanied by the biennial renewal fee prescribed by the board. A license which has expired for failure of the holder to renew may only be restored after application and payment of the prescribed restoration fee within the time period established by the division director and provided the applicant meets such requirements as the board may establish by rule. Any license which has not been restored within such period following its expiration may not be renewed, restored, or reissued thereafter. The holder of such a canceled license may apply for and obtain a valid license only upon compliance with all relevant requirements for issuance of a new license. The board shall require no less than four hours of continuing education in order to renew any license issued pursuant to this chapter. 43-33-17. Training permits (a) The board may issue a training permit to an applicant who is a graduate of an approved physical therapy program who is approved to take the physical therapy licensing examination or who has taken the examination but not yet received the examination results. (b) The board may issue a training permit to a foreign trained applicant who is a graduate from a physical therapy program outside the United States and its territories and who is approved to take the physical therapy licensing examination. (c) The board may issue a training permit to a reinstatement applicant whose license to practice as a physical therapist or license to practice as a physical therapist assistant has been expired for more than two years. (d) The training permit shall allow the holder thereof to work only under the direct supervision of a physical therapist who has been approved by the board and has practiced for not less than one year prior to assuming the supervisory role. 17 of 85

(e) Training permits are governed by rules and regulations authorized under this chapter and approved by the board. 43-33-18. Refusal to grant or restore licenses; discipline of licensees; suspension, revocation, or restriction of licenses; immunity for violation reporters a) The board shall have authority to refuse to grant or restore a license to an applicant or to discipline a physical therapist licensed under this chapter upon a finding by the board that the licensee or applicant has: (1) Identified himself or herself as a doctor without also clearly informing the public of his or her professional credential as a physical therapist; (2) Performed physical therapy care and services without examination and evaluation of patients or clients in order to determine a physical therapy diagnosis, prognosis, and plan of intervention, which, in the case of patients who have self-referred, means the physical therapist has: (A) Failed to refer the patient to an individual licensed pursuant to Article 2 of Chapter 11 of Title 43 or Article 2 of Chapter 34 of Title 43 if at any time the physical therapist has reason to believe that the patient has symptoms or conditions that require treatment beyond the scope of practice of the physical therapist or, regardless of the patient's condition, if after 21 days or eight visits from the initiation of a physical therapy plan of intervention, the physical therapist has not received a referral from the patient's provider who is licensed pursuant to Article 2 of Chapter 11 of Title 43 or Article 2 of Chapter 34 of Title 43. The day and visit limitations contained in this subparagraph shall not apply: (i) In the case of services provided for health promotion, wellness, fitness, or maintenance purposes, in which case the physical therapist shall refer a client seen for health promotion, wellness, fitness, or maintenance purposes to an appropriate individual licensed pursuant to Article 2 or 4 of Chapter 34 of Title 43 if the client exhibits or develops signs and symptoms beyond the scope of practice of the physical therapist; (ii) In the case of a patient diagnosed within the previous nine months with a neuromuscular or developmental condition when the evaluation, treatment, or services are being provided for problems or symptoms associated with that previously diagnosed condition; or (iii) In the case of a patient diagnosed within the previous 90 days with a chronic musculoskeletal condition and noted by a current relevant document from an appropriate licensed health care provider; 18 of 85

(B) Ordered radiology, performed surgery, ordered laboratory or body fluid testing, diagnosed disease, or practiced medicine; (C) Failed to provide each self-referred patient with a written disclosure that a physical therapy diagnosis is not a medical diagnosis by a physician or based on radiological imaging and that such services might not be covered by the patient's health plan or insurer; (D) Not satisfied the additional requirements for seeing a patient who has selfreferred, which shall include: (i) A doctorate in physical therapy or equivalent degree from an accredited institution plus two years of clinical practice experience; (ii) A doctorate in physical therapy or equivalent and: (I) Post graduate certification; (II) American Board of Physical Therapy Specialties Board Certification; or (III) Residency or fellowship training; or (iii) Five years of clinical practice experience; or (E) Performed dry needling treatment interventions without consulting an individual licensed pursuant to Article 2 or 4 of Chapter 34 of Title 43; or (3) Acted in a manner inconsistent with generally accepted standards of physical therapy practice, regardless of whether actual injury to a patient occurs, or failed to provide the expected minimal standard of patient or client management, which shall include that: (A) A physical therapist is fully responsible for managing all aspects of the physical therapy care of each patient. A physical therapist shall provide: (i) The initial evaluation, determination of physical therapy diagnosis, prognosis, and plan of intervention and documentation of the initial evaluation; (ii) Periodic reevaluation and documentation of findings for each patient; and (iii) The documented episode of care for each patient, including the patient's response to the plan of intervention at the time of completion of the episode of care; (B) A physical therapist shall assure the qualifications of all physical therapist assistants and physical therapy aides under his or her direction and supervision; 19 of 85

(C) For each patient on each date of service, a physical therapist shall provide all of the intervention that requires the education, skills, knowledge, and abilities of a physical therapist; (D) A physical therapist shall determine the use of physical therapist assistants and physical therapy aides to ensure the delivery of care that is safe, effective, and efficient. A physical therapist may use physical therapy aides for designated routine tasks. A physical therapy aide shall work under the supervision of a physical therapist; (E) A physical therapist shall communicate the overall plan of care with the patient or the patient's legally authorized representative; (F) A physical therapist's responsibility shall include accurate documentation and billing of the services provided; (G) A physical therapist shall adhere to the recognized standards for professional conduct and code of ethics of the physical therapy profession as established by rule; and (H) A physical therapist shall ensure that he or she has liability coverage either independently or provided by the entity by which he or she is employed. (b) The board shall have authority to refuse to grant or restore a license to an applicant or to discipline a physical therapist assistant licensed under this chapter upon a finding by the board that the licensee or applicant has: (1) Worked outside the supervision of a physical therapist; (2) Failed to provide accurate documentation or billing of services provided; (3) Failed to adhere to the recognized standards of ethical conduct and code of ethics as established by rule; or (4) Acted in a manner inconsistent with generally accepted standards of the physical therapist assistant's scope of work, regardless of whether actual injury to the patient occurs. (c) The board shall have authority to refuse to grant or restore a license to an applicant or to discipline a physical therapist or physical therapist assistant licensed under this chapter or any antecedent law upon a finding by the board that the licensee or applicant has: (1) Displayed an inability or has become unable to practice as a physical therapist or as a physical therapist assistant with reasonable 20 of 85

skill and safety to patients by reason of illness, use of alcohol, drugs, narcotics, chemicals, or any other type of material, or as a result of any mental or physical condition: (A) In enforcing this paragraph the board may, upon reasonable grounds, require a licensee or applicant to submit to a mental or physical examination by an appropriate licensed health care provider designated by the board. The expense of such mental or physical examination shall be borne by the licensee or applicant. The results of such examination shall be admissible in any hearing before the board, notwithstanding any claim of privilege under a contrary rule of law or statute, (B) For the purposes of this paragraph, the board may, upon reasonable grounds, obtain any and all records relating to the mental or physical condition of a licensee or applicant, including psychiatric records; and such records shall be admissible in any hearing before the board, notwithstanding any privilege under a contrary rule of law or statute, including, but not limited to, Code Section 24-9-21. Every person who shall accept the privilege of practicing physical therapy in this state or who shall file an application to practice physical therapy in this state shall be deemed to have given his or her consent to the board's obtaining any such records and to have waived all objections to the admissibility of such records in any hearing before the board upon the grounds that the same constitute a privileged communication; and (C) If any licensee or applicant could, in the absence of this paragraph, invoke a privilege to prevent the disclosure of the results of the examination provided for in subparagraph (A) of this paragraph or the records relating to the mental or physical condition of such licensee or applicant obtained pursuant to subparagraph (B) of this paragraph, all such information shall be received by the board in camera and shall not be disclosed to the public, nor shall any part of the record containing such information be used against any licensee or applicant in any other type of proceeding; (2) Been convicted of a felony or crime involving moral turpitude in the courts of this state; or the United States, or the conviction of an offense in another jurisdiction which if committed in this state would be deemed a felony. For the purpose of this Code section, a "conviction" shall include a finding or verdict of guilty, a plea of guilty, or a plea of nolo contendere in a criminal proceeding regardless of whether the adjudication of guilt or sentence is withheld or not entered thereon pursuant to the provisions of 21 of 85

Code Sections 42-8-60 through 42-8-64, relating to first offenders, or any comparable rule or statute; (3) Knowingly made misleading, deceptive, untrue, or fraudulent representations to a patient, consumer, or other person or entity in connection with the practice of physical therapy or in any document connected therewith; practiced fraud or deceit or intentionally made any false statement in obtaining or attempting to obtain a license to practice physical therapy or as a physical therapist assistant; or made a false or deceptive biennial registration with the board; (4) Practiced physical therapy contrary to this Code section or to the rules and regulations of the board; knowingly aided, assisted, procured, or advised any person to practice physical therapy contrary to this Code section or to the rules and regulations of the board; or knowingly performed any act which in any way aids, assists, procures, advises, or encourages any unlicensed person to practice physical therapy; (5) Engaged in any unprofessional, unethical, deceptive, or deleterious conduct or practice harmful to the public, which conduct or practice need not have resulted in actual injury to any person; unprofessional conduct shall also include any departure from, or the failure to conform to, the minimal standards of acceptable and prevailing physical therapy practice or the failure to comply with the code of ethics of the board; (6) Failed to report to the board any act or omission of a licensee or applicant or any other person which violates the provisions of this subsection; or (7) Divided fees or agreed to divide fees received for professional services with any person, firm, association, corporation, or other entity for bringing or referring a patient. (d)(1) When the board finds that any person is unqualified to be granted a license or finds that any person should be disciplined pursuant to subsection (a) of this Code section, the board may take any one or more of the following actions: (A) Refuse to grant or restore a license to an applicant; (B) Administer a public or private reprimand, but a private reprimand shall not be disclosed to any person except the licensee; (C) Suspend any license for a definite period; (D) Limit or restrict any license; 22 of 85

(E) Revoke any license; (F) Condition the penalty or withhold formal disposition, upon the physical therapist's, physical therapist assistant's, or other person's submission to the care, counseling, or treatment of physicians or other professional persons, and the completion of such care, counseling, or treatment, as directed by the board; or (G) Impose a fine not to exceed $500.00 for each violation of law, rule, or regulation of the board. (2) In addition to or in conjunction with the actions enumerated pursuant to paragraph (1) of this subsection the board may make a finding adverse to the licensee or applicant but withhold imposition of judgment and penalty, or it may impose the judgment and penalty but suspend enforcement thereof and place the licensee or applicant on probation, which probation may be vacated upon noncompliance with such reasonable terms as the board may impose. (e) In its discretion, the board may restore and reissue a license issued under this chapter or any antecedent law and, as a condition thereof, it may impose any disciplinary or corrective measure provided in this chapter. (f) A person, firm, corporation, association, authority, or other entity shall be immune from civil and criminal liability for reporting the acts or omissions of a licensee or applicant which violate the provisions of subsection (a), (b), or (c) of this Code section or any other provision of law relating to a licensee's or applicant's fitness to practice as a physical therapist or as a physical therapist assistant, if such report is made in good faith without fraud or malice. Any person who testifies without fraud or malice before the board in any proceeding involving a violation of the provisions of subsection (a), (b), or (c) of this Code section or any other law relating to a licensee's or applicant's fitness to practice as a physical therapist or as a physical therapist assistant shall be immune from civil and criminal liability for so testifying. (g) The provisions of this Code section shall not prevent any other health care provider from administering techniques authorized within his or her scope of practice 43-33-19. Unlicensed practice as constituting public nuisance; injunctions The practice of physical therapy is declared to be an activity affecting the public interest and involving the health, safety, and welfare of the public. Such practice when engaged in by a person who is not licensed is declared to be harmful to the public health, safety, and welfare. The board or the 23 of 85

district attorney of the circuit where such unlicensed practice exists, or any person or organization having an interest therein, may bring a petition to restrain and enjoin such unlicensed practice in the superior court of the county where such unlicensed person resides. It shall not be necessary in order to obtain an injunction under this Code section to allege or prove that there is no adequate remedy at law, or to allege or prove any special injury. 43-33-20. Penalty Any person convicted of violating this chapter shall be guilty of a misdemeanor. 43-33-21. Termination Repealed by Ga. L. 1992, p. 3137, 26, effective July 1, 1992. Rules of the Georgia State Board of Physical Therapy (Chapter 490) Chapter 490-1 Organization of the Board 490-1-.01 Organization of Board. The Board of Physical Therapy is composed of eight members who are appointed by the Governor. Members of the public may obtain information from the Board and make submissions or requests to the Board by contacting the Joint Secretary of the Professional Licensing Boards Division, 237 Coliseum Dr., Macon, GA 31217. Chapter 490-2 Licensure Requirements 490-2-.01 Application For Licensure And Examination. (1) A completed application for examination must be submitted and approved prior to taking the examination. (2) Any physical therapist or physical therapist assistant who plans to practice as a physical therapist or physical therapist assistant in the State of Georgia must be licensed by the Board prior to beginning said practice. 24 of 85

(3) Any applicant who does not submit required documentation within one year of initial filing date will not be given further consideration by the Board until submission of new application and payment of appropriate fees. (4) All applicants for licensure and examination are also subject to the provisions of O.C.G.A. 43-1-19 and 43-33-18. 490-2-.02 Licensure: Examination. (1) All physical therapists and physical therapist assistants are required to submit a completed application, the appropriate fee, and pass an examination for licensure to practice the profession in Georgia except as provided for in O.C.G.A. Sec. 43-33-15. The Board may at its discretion grant a license to an applicant who has previously taken and completed, within the requirements as set by the Board, the examination required. (a) All applicants who are graduates of Commission on Accreditation in Physical Therapy Education (CAPTE) accredited schools and are applying for licensure must submit: 1. passing scores from the national licensing examination; and 2. passing scores from examination on the laws governing the practice of physical therapy in Georgia and the rules of the Georgia State Board of Physical Therapy; and 3. official transcript from the institution granting the entry level degree in physical therapy or physical therapist assistant indicating the date of graduation. (b) Verification of licensure in all states in which the licensure candidate holds a license or has ever held a license may be conducted by board staff. 490-2-.09 Licensure: Endorsement. (1) The Board may, in its discretion register a physical therapist or physical therapist assistant without an examination as set forth in Official Code of Georgia Annotated Section 43-33-15 upon payment of applicable fees. (Refer to fee schedule) (2) Any applicant applying for licensure pursuant to O.C.G.A. 43-33-15 and who is a graduate of a physical therapy or physical therapist assistant program accredited by the Commission on Accreditation of Physical Therapy Education (CAPTE) and approved by the Board, must provide: (a) a list of all states where the applicant holds an active license; and (b) verification of licensure in good standing from the state board of all states in which the applicant has actively practiced in the two years immediately preceding the date of this application; and 25 of 85