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;
(10) Paraffin baths;
(11) Traction therapy;
(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
(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.