10.43.07.10

.10 Activities That May Be Performed by Chiropractic Assistants Under Indirect Supervision of a Supervising Chiropractor.

A. Indirect supervision may only be provided by a supervising chiropractor to a chiropractic assistant who is treating an established patient.

B. A chiropractic assistant may perform the following activities under the indirect supervision of a supervising chiropractor to an established patient with an established treatment program for not more than 10 percent of the treatment time in a given 30 days, without exceeding 3 consecutive days in a given week:

(1) Functional activities of daily living and hygiene;

(2) Gait practice, ambulation, administration, and observation of therapeutic exercises as prescribed by a supervising chiropractor;

(3) Assist in moving a patient within the treatment area;

(4) Contrast baths;

(5) Hot and cold packs;

(6) Hubbard tank;

(7) Infrared, ultraviolet irradiation, nonlaser light therapy, and nonablative therapeutic laser;

(8) Muscle stimulation;

(9) Electrotherapy;

(10) Paraffin baths;

(11) Traction therapy;

(12) Ultrasound;

(13) Whirlpool;

(14) Diathermy;

(15) Therapeutic massage, if licensed under Health Occupations Article, Title 6, Annotated Code of Maryland; and

(16) Mechanical or computerized examination procedures for the sole purpose of collecting data subject to the following conditions:

(a) All data will later be used and interpreted by the chiropractor to form a diagnosis and treatment plan; and

(b) No test may be performed that requires diagnosis or interpretation as part of the data collecting or testing procedure.

C. A chiropractic assistant who participates in indirect supervision shall be:

(1) In good standing with the Board; and

(2) Trained and proficient in the office’s indirect supervision protocol, which includes:

(a) Informed consent to the patient; and

(b) Immediate access to the supervising chiropractor.

D. The supervising chiropractor shall:

(1) Prior to the implementation of indirect supervision, establish and make readily available an:

(a) Emergency procedures protocol; and

(b) Indirect supervision protocol;

(2) Maintain a log of indirect supervision treatment, which includes:

(a) Patient’s name or identification information; and

(b) Treatment:

(i) Date;

(ii) Time initiated;

(iii) Duration; and

(iv) Procedure or activity provided; and

(3) Review or update, or both, indirect supervision orders every 30 days.

E. An indirect supervision protocol shall be listed on the office’s:

(1) Consent to treatment form signed by the patient; or

(2) Informed consent protocol.