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Chapter 490-9 CODE OF ETHICS

Rule 490-9-.01 Purpose

This code shall apply to all licensed physical therapists, physical therapists assistants, and all individuals recognized in the delivery of patient care under Chapter 33 of Title 43 in the State of Georgia. It is intended to provide guidelines by which the licensees and others can determine the propriety of conduct. Anyone found guilty of violating the ethical standards, as set forth in this chapter, shall be guilty of violating Official Code of Georgia Annotated Section 43-33-18(a)(6).

Rule 490-9-.02 Principles of Conduct for Physical Therapists

Any individual who is licensed as a physical therapist shall abide by the following ethical standard:

(1) Act with consideration, within the scope of physical therapy, for the rights and dignity of all individuals.
(a) The physical therapist shall hold as confidential information obtained while acting in a professional capacity.
(b) The physical therapist shall provide optimal physical therapy care for all patients regardless of patient race, gender, age, religion, disability or sexual preference.
(c) The physical therapist should balance considerations of the patient's physical, psychological and socioeconomic welfare in professional decisions and actions and document these considerations in the patient's record of care.
(d) The physical therapist shall communicate and interact with patients and all persons encountered in a professional capacity with courteous regard and timeliness.
(e) The physical therapist shall not engage in any behavior that constitutes harassment or abuse of a patient, professional colleague or associate.
(2) Comply with the laws and regulations governing the practice of physical therapy in the State of Georgia.
(a) Physical therapists are to practice (consultation, evaluations, treatment, research, education, administration and preventive care) in accordance with the state practice act.
(3) Accept responsibility for the exercise of sound judgment.
(a) When implementing treatment, physical therapists shall assume the responsibility for evaluating that individual; planning, implementing, and supervising the therapeutic program; reevaluating and changing the program; and maintaining adequate records of the case, including progress reports.
(b) When performing wellness and preventative services, physical therapists shall assume responsibility for providing optimal patient care.
(c) When the individual's needs are beyond the scope of the physical therapist's expertise, the physical therapist shall so inform and assist the individual in identifying a qualified person to provide the necessary services.
(d) When the physical therapists judge that benefit can no longer be obtained from their services, they shall so inform the individual receiving the services. It is unethical to initiate or continue services that, in the therapist's judgment, either cannot result in beneficial outcome or are contraindicated.
(e) The physical therapist's ability to make independent judgment must not be limited or compromised by professional affiliations, including employment relationships.
(f) Physical therapists are not to delegate to a less qualified person any activity which requires the unique skills, knowledge, and judgment of a physical therapist.
(g) The primary responsibility for physical therapy care assisted by supportive personnel rests with the supervising physical therapist. Adequate supervision requires, at a minimum, that a supervising physical therapist perform the following activities:
1. Establish effective channels of written and oral communication;
2. Interpret and communicate critical information about the patient to the supportive personnel;
3. Perform an initial evaluation of the patient;
4. Develop a plan of care, including short and long-term goals;
5. Delegate appropriate tasks to supportive personnel;
6. Assess the supportive personnel's competence to perform assigned tasks;
7. Provide supervision in accordance with the law, the patient's condition, and the specific situation;
8. Identify and document precautions, special programs, contraindications, goals, anticipated progress, and plans for re-evaluation;
9. Re-evaluate the patient, modify the plan of care when necessary, perform the final evaluation, and establish a follow-up plan.
(h) Physical therapists are obligated to advise their employer(s) of any practice which causes a physical therapist to be in conflict with the ethical principles of this section. Physical therapists are to attempt to rectify any aspect(s) of their employment which is in conflict with the principles of this section.
(4) Seek remuneration for their services that is deserved and reasonable.
(a) Fees for physical therapy services should be reasonable for the service performed, considering the setting in which it is provided, practice costs in the geographic area, judgment of other organizations, and other relevant factors.
(b) Physical therapists shall not:
1. directly or indirectly request, receive, or participate in the dividing, transferring, assigning, or rebating of an unearned fee;
2. profit by means of a credit or other valuable consideration, such as an unearned commission, discount, or gratuity in connection with furnishing of physical therapy services;
3. use influence upon individuals, or families of individuals under their care for utilization of any product or service based upon the direct or indirect financial interest of the physical therapist.
(5) Provide accurate information to the consumer about the profession and the services provided.
(a) Physical therapists are not to use, or participate in the use of, any form of communication containing false, plagiarized, fraudulent, misleading, deceptive, or unfair statements.
(6) Accept the responsibility to protect the public and the profession from unethical, incompetent, or illegal acts.
(a) Physical therapists shall report any activity which appears to be unethical, incompetent, or illegal to the proper authorities.
(b) Physical therapists shall not participate in any arrangement in which patients are exploited due to the referring sources enhancing their personal incomes as a result of referring, prescribing, or recommending physical therapy or a specific physical therapy practice.
(c) If a physical therapist is involved in an arrangement with a referring source in which income is derived from the services, the physical therapist has an obligation to disclose to the patient, within the scope of the state law, the nature of the income.

Rule 490-9-.03 Principles of Conduct for Physical Therapist Assistants

Any individual who is licensed as a physical therapist assistant shall abide by the following ethical standards:

(1) Act with consideration, within the scope of physical therapy, for the rights and dignity of all individuals.
(a) The physical therapist assistant shall hold as confidential information obtained while functioning as a physical therapist assistant.
(b) The physical therapist assistant shall provide optimal physical therapy care for all patients delegated by the physical therapist regardless of patient race, gender, age, religion, disability or sexual preference.
(c) The physical therapist assistant should be aware of the patient's physical, psychological and socioeconomic welfare in decisions and actions taken while rendering treatment.
(d) The physical therapist assistant shall communicate and interact with patients and all persons encountered with courteous regard and timeliness.
(e) The physical therapist assistant shall not engage in any behavior that constitutes harassment or abuse of a patient, professional colleague or associate.
(2) Comply with the laws and regulations governing the practice of physical therapy in the State of Georgia.
(a) Physical therapist assistants are to practice only under the supervision of a licensed physical therapist.
(3) Accept responsibility for the exercise of sound judgement.
(a) Upon accepting delegation from a physical therapist, the physical therapist assistant shall provide services within the plan of care established by the physical therapist.
(b) When the individual's needs are beyond the scope of the physical therapist assistant's expertise, the physical therapist assistant shall inform the supervising physical therapist.
(c) When the physical therapistassistant determines that a change in the plan of care is needed, the assistant will contact the supervising physical therapist and request reevaluation of the patient's status.
(d) When the physical therapist assistant determines that the patient has received maximum benefits from physical therapy, he/she shall so inform the supervising physical therapist.
(e) Physical therapist assistants are not to delegate to a less qualified person any activity which requires the unique skills, knowledge, and judgement of a physical therapist assistant.
(f) The primary responsibility for physical therapy care assisted by supportive personnel rests with the supervising physical therapist. Adequate supervision is the responsibility of both the physical therapist and the physical therapist assistant. To insure appropriate supervision, the physical therapist assistant is expected to:
1. Maintain effective channels of written and oral communication.
2. Communicate critical information about the patient to the supervising physical therapist in a timely manner.
3. Function within the established plan of care.
4. Identify and document treatment activities and all special occurrences.
5. Request re-evaluation of the patient and/or modification of the plan of care when necessary.
(g) Physical therapist assistants are obligated to advise their employer(s) of any practice which causes a physical therapist or a physical therapist assistant to be in conflict with the ethical principles of this section. Physical therapist assistants are to attempt to rectify any aspect(s) of their employment which is in conflict with the principles of this section.
(4). Seek remuneration for their services that is deserved and reasonable.
(a) Physical therapist assistants shall not:
1. Directly or indirectly request, receive, or participate in the dividing, transferring, assigning, or rebating of an unearned fee;
2. Profit by means of a credit or other valuable consideration, such as an unearned commission, discount, or gratuity in connection with furnishing of physical therapy services;
3. Use influence upon individuals, or families of individuals under their care for utilization of any product or service based upon the direct or indirect financial interest of the physical therapist assistant;
(5) Provide accurate information to the consumer about the profession and the services provided.
(a) Physical therapist assistants are not to use, or participate in the use of, any form of communication containing false, plagiarized, fraudulent, misleading, deceptive, or unfair statements.
(6) Accept the responsibility to protect the public and the profession from unethical, incompetent, or illegal acts.
(a) Physical therapist assistants shall report any activity which appears to be unethical, incompetent, or illegal to the proper authorities.
(b) Physical therapist assistants shall not participate in any arrangement in which patients are exploited due to the referring sources enhancing their personal incomes as a result of referring, prescribing, or recommending physical therapy or a specific physical therapy practice.
(c) If a physical therapist assistant is involved in an arrangement with a referring source in which income is derived from the services, the physical therapist assistant has an obligation to disclose to the patient, within the scope of the State Law, the nature of the income.

Rule 490-9-.04 Disciplinary Sanctions

When providing physical therapy treatment following appropriate consultation, unprofessional and unethical conduct shall include but is not limited to the following:

(a) Failing to adhere to the Code of Ethics for Physical Therapists and Physical Therapists Assistants, as codified in Rules 490-9-.01 through 490-9-.03.
(b) Delegating to an aide or unlicensed person any physical therapy task other than those codified in Chapter 490-8.
(c) Failing to provide continuous, immediate and physically present supervision of the aide or unlicensed person when designated tasks are performed.
(d) Performing the technique of dry needling without having met the training and competency requirements as codified in Rule 490-9-.05.
(e) Failing to adhere to the 'Consumer Information and Awareness Act' as codified in O.C.G.A. § 43-1-33 in relation to conspicuously posting and affirmatively communicating your type of regulatory designator (PT, PTA), level of education, and training to all current and prospective patients by way of a name badge, facility notices and advertisements.
(f) Failing to provide an evaluation on each patient and establishing a physical therapy diagnosis.
(g) Failing to formulate and record in the patient's record a treatment program based upon the evaluation and any other information available.
(h) Failing to perform periodic evaluation of the patient and documenting the evaluations in the patient's record and to make adjustments to the patient's treatment program as progress warrants.
(i) Failing to formulate and record a patient's discharge plan.
(j) Directly or indirectly requesting, receiving or participating in the division, transferring, assigning, rebating or refunding of fees or remuneration earned, in cash or kind, for bringing or referring a patient. For purposes of this Rule:
1. No physical therapist, physical therapy assistant, employee or agent thereof acting on his behalf, shall enter into or engage in any agreement or arrangement with any individual, entity, or an employee or agent thereof acting on his behalf, for the payment or acceptance or compensation in any form for the referral or recommending of the professional services of either. This prohibition includes any form of fee division or charging of fees solely for referral of a patient.
2. This prohibition shall include a rebate or percentage of rental agreement or any arrangement or agreement whereby the amount received in payment for furnishing space, facilities, equipment or personnel services.
3. Provided further, that this Rule shall not preclude a discount, waiver of co-payment or other reduction in price of services by a physical therapist if the reduction in price is properly disclosed to the consumer and third party payers and appropriately reflected in the costs claimed or charges made.
(k) Should it be determined that a licensee is in violation of this rule and the statutes referenced herein, the Board may impose any disciplinary or corrective measure allowed by law.

Rule 490-9-.05 Dry Needling

(1) Dry needling is a skilled technique performed by a physical therapist using filiform needles to penetrate the skin and underlying tissues to affect change in body structures and functions for the evaluation and management of neuromusculoskeletal conditions, pain, movement impairments, and disability for preventative and therapeutic purposes.
(2) Dry needling must be performed by a licensed physical therapist who:
(a) Has consulted with an individual licensed pursuant to Article 2 or 4 of Chapter 34 of Title 43; and,
(b) Is specifically trained and competent by virtue of education and training to perform dry needling. Online study for dry needling instruction, with the exception of OSHA Blood Borne Pathogens Standards, will not be accepted as a demonstration of competence and training.
(3) A physical therapist has demonstrated specific and competent education and training when the licensee has submitted the following documentation to the Board:
(a) Proof of education in the OSHA Blood Borne Pathogens Standard: and,
(b) At least one of the following:
1. Proof of graduation from an entry-level physical therapy program that included dry needling instruction consisting of a minimum of 50 hours total and a competency assessment of achievement in its curriculum; or
2. Proof of graduation from a post-graduate credentialed residency or fellowship program of study that included dry needling instruction consisting of a minimum of 50 hours total and a competency assessment of achievement in its curriculum; or
3. Proof of documented, successful completion of a didactic dry needling course of study consisting of a minimum of 50 hours total and a competency assessment of achievement in its curriculum.
(4) Effective July 1, 2018, to perform dry needling in the state of Georgia licensed physical therapists and physical therapists applying for licensure must submit documentation of dry needling education and training into the online recording and reporting system approved by the Board.
(a) For the purposes of this requirement, the Georgia State Board of Physical Therapy adopts the utilization of CE Broker.
(b) Licensees and applicants shall incur no additional costs from CE Broker for this service.
(c) Every licensee or applicant subject to the rules of the Georgia State Board of Physical Therapy shall be deemed to have given such person's consent to the Board and its representatives to access their record retained within the online database for the purposes of auditing and verifying completion of the requirements for dry needling. Such person waives all objections to the admissibility of the record in any proceedings or hearings before the board.
(5) At the time of license renewal, each licensed physical therapist approved to perform dry needling shall attest that he or she is practicing dry needling in the state of Georgia in accordance to the rules and regulations of the Georgia State Board of Physical Therapy.
(6) A violation of the provisions outlined in this Board rule or a false attestation on the renewal application is grounds for disciplinary action as determined by the Board.

Rule 490-9-.06 Telehealth

(1) The purpose of this rule is to define and establish guidelines for the practice of telehealth by the spectrum of technologies involving interactive physical therapy services.
(2) Telehealth has been defined as the use of electronic communications to provide and deliver a host of health related information and health care services including, but not limited to physical therapy related information and services, over large and small distances. Telehealth encompasses a variety of health care and health promotion activities including, but not limited to, education, advice, reminders, interventions, and monitoring of interventions. All provisions of Physical Therapy utilizing telehealth mechanisms must:
(a) conform to all Federal and State statutes, rules, regulations and policies governing the practice of physical therapy in the State of Georgia.
(b) With the exception of practices and services identified in O.C.G.A. § 43-33-11(d), individuals providing physical therapy via telehealth to a patient/client in the State of Georgia must be licensed in the State of Georgia.
(c) A physical therapist that is licensed in another jurisdiction of the United States may provide a consultation via telehealth to a physical therapist in the state of Georgia.