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RULE §78.3Delegation of Authority

(a) The purpose of this section is to encourage the more effective use of the skills of licensees by establishing guidelines for the delegation of chiropractic care tasks to a qualified and properly trained person acting under a licensee's supervision to ensure proper diligence and efficient practice of chiropractic. This section provides the standards for credentialing a chiropractic assistant in Texas.

(b) Except as provided in this section, a licensee shall not allow or direct a person who is not licensed by the board to perform procedures or tasks that are within the scope of chiropractic, including:

  (1) rendering a diagnosis and prescribing a treatment plan; or

  (2) performing a chiropractic adjustment or manipulation.

(c) A licensee may allow or direct a student enrolled in an accredited chiropractic college to perform chiropractic adjustments or manipulations if that student has qualified for admission to the outpatient clinic at the aforementioned college. The chiropractic adjustment or manipulation must be performed under the supervision of a licensee who need not be physically present in the treating room at the time of the adjustment or manipulation, but must be on-site at the time of the adjustment or manipulation.

(d) A licensee may allow or direct certain recent graduates of an accredited chiropractic college to perform chiropractic adjustments or manipulations. A "recent graduate" is one who graduated from a chiropractic college accredited by the Council on Chiropractic Education (CCE) within the previous twelve (12) months.

  (1) The licensee shall notify the Board in writing within ten (10) days of the graduate's hire/employment date and provide the name of each recent graduate, the name of the chiropractic college and date of graduation, a copy of the graduate's diploma, and the name and license number of the licensee supervising the graduate.

  (2) The supervising chiropractor shall notify the Board within ten (10) days of the graduate's status as contained within this section.

(e) In delegating the performance of a specific task or procedure, a licensee shall verify that a person is qualified and properly trained. "Qualified and properly trained" as used in this section means that the person has the requisite education, training, and skill to perform a specific task or procedure.

  (1) Requisite education may be determined by a license, degree, coursework, on-the-job training, or relevant general knowledge.

  (2) Requisite training may be determined by instruction in a specific task or procedure, relevant experience, or on-the-job training.

  (3) Requisite skill may be determined by a person's talent, ability, and fitness to perform a specific task or procedure.

  (4) A licensee may delegate a specific task or procedure to an unlicensed person if the specific task or procedure is within the scope of chiropractic and if the delegation complies with the other requirements of this section, the Chiropractic Act, and the board's rules.

(f) A licensee may allow or direct a qualified and properly trained person, who is acting under the licensee's delegation, to perform a task or procedure that assists the doctor of chiropractic in making a diagnosis, prescribing a treatment plan or treating a patient if the performance of the task or procedure does not require the training of a doctor of chiropractic in order to protect the health or safety of a patient, such as:

  (1) taking the patient's medical history;

  (2) taking or recording vital signs;

  (3) performing radiologic procedures;

  (4) taking or recording range of motion measurements;

  (5) performing other prescribed clinical tests and measurements;

  (6) performing prescribed physical therapy modalities, therapeutic procedures, physical medicine and rehabilitation, or other treatments as described in the American Medical Association's Current Procedural Terminology Codebook, the Centers for Medicare and Medicaid Services' Health Care Common Procedure Coding System, or other national coding system;

  (7) demonstrating prescribed exercises or stretches for a patient; or

  (8) demonstrating proper uses of dispensed supports and devices.

(g) A licensee may not allow or direct a person:

  (1) to perform activities that are outside the licensee's scope of practice;

  (2) to perform activities that exceed the education, training, and skill of the person or for which a person is not otherwise qualified and properly trained; or

  (3) to exercise independent clinical judgment unless the person holds a valid Texas license or certification that would allow or authorize the person to exercise independent clinical judgment.

(h) A licensee shall not allow or direct a person whose chiropractic license has been suspended or revoked, in Texas or any other jurisdiction, to practice chiropractic in connection with the treatment of a patient of the licensee during the effective period of the suspension or upon revocation.

(i) A licensee is responsible for and will participate in each patient's care. A licensee shall conform to the minimal acceptable standards of practice of chiropractic in assessing and evaluating each patient's status.

(j) It is the responsibility of each licensee to determine the number of qualified and properly trained persons that the licensee can safely supervise. A licensee must be on-call when any or all treatment is provided under the licensee's direction unless there is another licensee present on-site or designated as being on-call. On-call means that the licensee must be available for consultation within 15 minutes either in person or by other means of telecommunication.

(k) A licensee's patient records shall differentiate between services performed by a doctor of chiropractic and the services performed by a person under the licensee's supervision.

(l) No provision contained within this section authorizes a chiropractor to delegate tasks or care to a subordinate in abrogation of any established law, code or provision to the contrary.

Source Note: The provisions of this §78.3 adopted to be effective September 10, 2015, 40 TexReg 5785; transferred effective November 1, 2018, as published in the Texas Register October 19, 2018, 43 TexReg 6963

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