|(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,
(1) rendering a diagnosis and prescribing a treatment
(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
(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
(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
(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
(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
(7) demonstrating prescribed exercises or stretches
for a patient; or
(8) demonstrating proper uses of dispensed supports
(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