A. Contents. The evaluation and treatment protocol shall include the following:
(1) Identification, licensure information, and signature of the:
(a) Licensed athletic trainer; and
(b) Licensed supervising physician;
(2) Information about the locations where the athletic trainer will practice, including both of the following:
(a) Address of the primary location; and
(b) Identification of the setting for each location;
(3) Description of the supervision mechanism that applies to each setting;
(4) Description of the delegated processes and procedures that the athletic trainer may use in each of the following areas:
(a) Injury or illness prevention and wellness;
(b) Clinical evaluation and assessment;
(c) Immediate and emergency care;
(d) Treatment, rehabilitation, and reconditioning; and
(e) Organizational and professional well-being;
(5) Descriptions of tasks which the athletic trainer may not perform;
(6) Description of specialized tasks the supervising physician is delegating to the athletic trainer to perform with documentation of competencies, certification, credentials, or any other requirements established by the Board to support the delegation of the specialized tasks;
(7) A statement of whether or not the supervising physician will permit the athletic trainer to accept outside referrals meeting the requirements stated in Regulation .05F of this chapter;
(8) If applicable, the name and other relevant information about an alternate supervising physician; and
(9) An attestation that states that the supervising physician will be responsible for providing ongoing and immediately available instruction that is adequate to ensure the safety and welfare of a patient and is appropriate to the setting.
B. Process and Approval.
(1) A licensed athletic trainer and the athletic trainerís supervising physician shall submit an evaluation and treatment protocol on a form approved by the Board.
(a) Except as provided in §B(2)(b) of this regulation, the applicants shall pay a fee as specified in Regulation .08 of this chapter.
(b) The evaluation and treatment protocol fee shall be waived for an evaluation and treatment protocol received by the Board on or before September 30, 2012.
(3) A licensed athletic trainer may not practice athletic training:
(a) Before the Board has approved the evaluation and treatment protocol between the supervising physician and the athletic trainer;
(b) Beyond the scope of practice delegated by the supervising physician in the Board-approved evaluation and treatment protocol; or
(c) In a location not identified in the Board-approved evaluation and treatment protocol.
C. Termination of Evaluation and Treatment Protocol.
(1) If the athletic trainer or the supervising physician terminates the evaluation and treatment protocol, the athletic trainer shall cease practicing until another evaluation and treatment protocol is approved by the Board.
(2) The supervising physician shall report the termination of an evaluation and treatment protocol for any reason to the Board within 10 days of the termination and provide the following information:
(a) Name and license number of supervising physician and athletic trainer; and
(b) Reason for termination, including a description of conduct or incident that resulted in the termination.
D. Emergency Evaluation and Treatment Protocol. In the event of a sudden departure, incapacity, or death of a supervising physician, a designated alternate may assume the role of the supervising physician by submitting a new evaluation and treatment protocol to the Board within 15 days.