RCW ch. 18.74 — Revised Code of Washington Chapter 18.74 RCW — Physical Therapy

RCW 18.74.005 Purpose of chapter. The purpose of this chapter is to protect the public health, safety, and welfare, and to provide for state administrative control, supervision, licensure, and regulation of the practice of physical therapy. It is the intent of the legislature that only individuals who meet and maintain prescribed standards of competence and conduct be allowed to engage in the practice of physical therapy as defined and authorized by this chapter. [ 2005 c 501 s 1; 1983 c 116 s 1.] RCW 18.74.010 Definitions. The definitions in this section apply throughout this chapter unless the context clearly requires otherwise. (1) "Authorized health care practitioner" means and includes licensed physicians, osteopathic physicians, chiropractors, naturopaths, podiatric physicians and surgeons, dentists, and *advanced registered nurse practitioners: PROVIDED, HOWEVER, That nothing herein shall be construed as altering the scope of practice of such practitioners as defined in their respective licensure laws. (2) "Board" means the board of physical therapy created by RCW 18.74.020. (3) "Close supervision" means that the supervisor has personally diagnosed the condition to be treated and has personally authorized the procedures to be performed. The supervisor is continuously on-site and physically present in the operatory while the procedures are performed and capable of responding immediately in the event of an emergency. (4) "Department" means the department of health. (5) "Direct supervision" means the supervisor must (a) be continuously on-site and present in the department or facility where the person being supervised is performing services; (b) be immediately available to assist the person being supervised in the services being performed; and (c) maintain continued involvement in appropriate aspects of each treatment session in which a component of treatment is delegated to assistive personnel or is required to be directly supervised under RCW 18.74.190. (6) "Indirect supervision" means the supervisor is not on the premises, but has given either written or oral instructions for treatment of the patient and the patient has been examined by the physical therapist at such time as acceptable health care practice requires and consistent with the particular delegated health care task. (7) "Intramuscular needling," also known as "dry needling," means a skilled intervention that uses a single use, sterile filiform needle to penetrate the skin and stimulate underlying myofascial trigger points and connective and muscular tissues for the evaluation and management of neuromusculoskeletal pain and movement impairments. Intramuscular needling requires an examination and diagnosis. Intramuscular needling does not include needle retention without stimulation or the stimulation of auricular and distal points. (8) "Physical therapist" means a person who meets all the requirements of this chapter and is licensed in this state to practice physical therapy. (9)(a) "Physical therapist assistant" means a person who meets all the requirements of this chapter and is licensed as a physical therapist assistant and who performs physical therapy procedures and related tasks that have been selected and delegated only by the supervising physical therapist. However, a physical therapist may not delegate sharp debridement to a physical therapist assistant. (b) "Physical therapy aide" means an unlicensed person who receives ongoing on-the-job training and assists a physical therapist or physical therapist assistant in providing physical therapy patient care and who does not meet the definition of a physical therapist, physical therapist assistant, or other assistive personnel. A physical therapy aide may directly assist in the implementation of therapeutic interventions, but may not alter or modify the plan of therapeutic interventions and may not perform any procedure or task which only a physical therapist may perform under this chapter. (c) "Other assistive personnel" means other trained or educated health care personnel, not defined in (a) or (b) of this subsection, who perform specific designated tasks that are related to physical therapy and within their license, scope of practice, or formal education, under the supervision of a physical therapist, including but not limited to licensed massage therapists, athletic trainers, and exercise physiologists. At the direction of the supervising physical therapist, and if properly credentialed and not prohibited by any other law, other assistive personnel may be identified by the title specific to their license, training, or education. (10) "Physical therapy" means the care and services provided by or under the direction and supervision of a physical therapist licensed by the state. Except as provided in RCW 18.74.190, the use of Roentgen rays and radium for diagnostic and therapeutic purposes, the use of electricity for surgical purposes, including cauterization, and the use of spinal manipulation, or manipulative mobilization of the spine and its immediate articulations, are not included under the term "physical therapy" as used in this chapter. (11) "Practice of physical therapy" is based on movement science and means: (a) Examining, evaluating, and testing individuals with mechanical, physiological, and developmental impairments, functional limitations in movement, and disability or other health and movement-related conditions in order to determine a diagnosis, prognosis, plan of therapeutic intervention, and to assess and document the ongoing effects of intervention; (b) Alleviating impairments and functional limitations in movement by designing, implementing, and modifying therapeutic interventions that include therapeutic exercise; functional training related to balance, posture, and movement to facilitate self-care and reintegration into home, community, or work; manual therapy including soft tissue and joint mobilization and manipulation; therapeutic massage; assistive, adaptive, protective, and devices related to postural control and mobility except as restricted by (c) of this subsection; airway clearance techniques; physical agents or modalities; mechanical and electrotherapeutic modalities; and patient-related instruction; (c) Training for, and the evaluation of, the function of a patient wearing an orthosis or prosthesis as defined in RCW 18.200.010. Physical therapists may provide those direct-formed and prefabricated upper limb, knee, and ankle-foot orthoses, but not fracture orthoses except those for hand, wrist, ankle, and foot fractures, and assistive technology devices specified in RCW 18.200.010 as exemptions from the defined scope of licensed orthotic and prosthetic services. It is the intent of the legislature that the unregulated devices specified in RCW 18.200.010 are in the public domain to the extent that they may be provided in common with individuals or other health providers, whether unregulated or regulated under this title, without regard to any scope of practice; (d) Performing wound care services that are limited to sharp debridement, debridement with other agents, dry dressings, wet dressings, topical agents including enzymes, hydrotherapy, electrical stimulation, ultrasound, and other similar treatments. Physical therapists may not delegate sharp debridement. A physical therapist may perform wound care services only by referral from or after consultation with an authorized health care practitioner; (e) Performing intramuscular needling; (f) Reducing the risk of injury, impairment, functional limitation, and disability related to movement, including the promotion and maintenance of fitness, health, and quality of life in all age populations; and (g) Engaging in administration, consultation, education, and research. (12) "Secretary" means the secretary of health. (13) "Sharp debridement" means the removal of devitalized tissue from a wound with scissors, scalpel, and tweezers without anesthesia. "Sharp debridement" does not mean surgical debridement. A physical therapist may perform sharp debridement, to include the use of a scalpel, only upon showing evidence of adequate education and training as established by rule. Until the rules are established, but no later than July 1, 2006, physical therapists licensed under this chapter who perform sharp debridement as of July 24, 2005, shall submit to the secretary an affidavit that includes evidence of adequate education and training in sharp debridement, including the use of a scalpel. (14) "Spinal manipulation" includes spinal manipulation, spinal manipulative therapy, high velocity thrust maneuvers, and grade five mobilization of the spine and its immediate articulations. (15) Words importing the masculine gender may be applied to females. [ 2023 c 198 s 1; 2018 c 222 s 1; 2016 c 41 s 16. Prior: 2014 c 116 s 3; 2007 c 98 s 1; 2005 c 501 s 2; 1997 c 275 s 8; 1991 c 12 s 1; (1991 c 3 ss 172, 173 repealed by 1991 sp.s. c 11 s 2); (1990 c 297 s 17 repealed by 1991 c 12 s 6); 1988 c 185 s 1; 1983 c 116 s 2; 1961 c 64 s 1; 1949 c 239 s 1; Rem. Supp. 1949 s 10163-1.] NOTES: Reviser's note: RCW 18.74.012 Consultation with health care practitioner not required for certain treatments. A consultation and periodic review by an authorized health care practitioner is not required for treatment of neuromuscular or musculoskeletal conditions. [ 2005 c 501 s 3; 2000 c 171 s 24; 1991 c 12 s 2; 1990 c 297 s 19; 1988 c 185 s 2.] NOTES: Effective dates— RCW 18.74.015 Referral to health care practitioners—When required. (1) Physical therapists shall refer persons under their care to authorized health care practitioners if they have reasonable cause to believe symptoms or conditions are present which require services beyond the scope of their practice or for which physical therapy is contraindicated. (2) A violation of this section is unprofessional conduct under this chapter and chapter 18.130 RCW. [ 1988 c 185 s 3.] RCW 18.74.020 Board created—Members—Staff assistance—Compensation and travel expenses. The state board of physical therapy is hereby created. The board shall consist of seven members who shall be appointed by the governor. Five members of the board shall be physical therapists licensed under this chapter and residing in this state, shall have not less than five years' experience in the practice of physical therapy, and shall be actively engaged in practice within two years of appointment. One member shall be a physical therapist assistant licensed under this chapter and residing in this state, shall not have less than five years' experience in the practice of physical therapy, and shall be actively engaged in practice within two years of appointment. The seventh member shall be appointed from the public at large, shall have an interest in the rights of consumers of health services, and shall not be or have been a member of any other licensing board, a licensee of any health occupation board, an employee of any health facility nor derive his or her primary livelihood from the provision of health services at any level of responsibility. In the event that a member of the board for any reason cannot complete his or her term of office, another appointment shall be made by the governor in accordance with the procedure stated in this section to fill the remainder of the term. No member may serve for more than two consecutive full four-year terms. The secretary of health shall furnish such secretarial, clerical, and other assistance as the board may require. Each member of the board shall, in addition to travel expenses in accordance with RCW 43.03.050 and 43.03.060, be compensated in accordance with RCW 43.03.265. The board is designated as a class five group for purposes of chapter 43.03 RCW. [ 2022 c 240 s 5; 2007 c 98 s 2; 1991 c 3 s 174; 1984 c 287 s 46; 1983 c 116 s 3; 1979 c 158 s 62; 1975-'76 2nd ex.s. c 34 s 44; 1949 c 239 s 2; Rem. Supp. 1949 s 10163-2.] NOTES: Legislative findings— RCW 18.74.023 Board—Powers and duties. The board has the following powers and duties: (1) To develop and administer, or approve, or both, examinations to applicants for a license under this chapter. (2) To pass upon the qualifications of applicants for a license and to certify to the secretary duly qualified applicants. (3) To make such rules not inconsistent with the laws of this state as may be deemed necessary or proper to carry out the purposes of this chapter. (4) To establish and administer requirements for continuing competency, which shall be a prerequisite to renewing a license under this chapter. (5) To keep an official record of all its proceedings, which record shall be evidence of all proceedings of the board which are set forth therein. (6) To adopt rules not inconsistent with the laws of this state, when it deems appropriate, in response to questions put to it by professional health associations, physical therapists, and consumers in this state concerning the authority of physical therapists to perform particular acts. (7) To adopt rules to define and specify the education and training requirements for physical therapist assistants and physical therapy aides. [ 1995 c 299 s 1; 1995 c 198 s 9. Prior: 1991 c 12 s 3; 1991 c 3 s 175; 1986 c 259 s 124; 1983 c 116 s 4.] NOTES: Reviser's note: RCW 18.74.025 Standards for appropriateness of physical therapy care—Violation. Pursuant to the board's power in RCW 18.74.023(3), the board is directed to adopt rules relating to standards for appropriateness of physical therapy care. Violation of the standards adopted by rule under this section is unprofessional conduct under this chapter and chapter 18.130 RCW. [ 1991 c 12 s 5.] RCW 18.74.027 Board—Officers—Meetings—Quorum. The board shall elect from its members a chairperson and vice chairperson-secretary, who shall serve for one year and until their successors are elected. The board shall meet at least once a year and upon the call of the chairperson at such times and places as the chairperson designates. A majority of the board members appointed and serving constitutes a quorum for the transaction of board business. The affirmative vote of a majority of a quorum of the board is required to carry a motion or resolution, to adopt a rule, or to pass a measure. Meetings of the board shall be open and public, except the board may hold executive sessions to the extent permitted by chapter 42.30 RCW. [ 2022 c 240 s 6; 1983 c 116 s 5.] RCW 18.74.029 Application of Uniform Disciplinary Act. The Uniform Disciplinary Act, chapter 18.130 RCW, governs unlicensed practice, the issuance and denial of licenses and interim permits, and the discipline of licensees and holders of interim permits under this chapter. [ 1993 c 133 s 2; 1987 c 150 s 47; 1986 c 259 s 123.] NOTES: Severability— RCW 18.74.030 Qualifications of applicants. (1) An applicant for a license as a physical therapist shall have the following minimum qualifications: (a) Be of good moral character; and (b) Have obtained either (i) a baccalaureate degree in physical therapy from an institution of higher learning approved by the board or (ii) a baccalaureate degree from an institution of higher learning and a certificate or advanced degree from a school of physical therapy approved by the board. (2) An applicant for a license as a physical therapist assistant must have the following minimum qualifications: (a) Be of good moral character; and (b) Have successfully completed a board-approved physical therapist assistant program. (3) The applicant shall present proof of qualification to the board in the manner and on the forms prescribed by the board. [ 2007 c 98 s 3; 1983 c 116 s 6; 1961 c 64 s 2; 1949 c 239 s 3; Rem. Supp. 1949 s 10163-3.] RCW 18.74.033 Qualifications—Military training and experience. An applicant with military training or experience satisfies the training and experience requirements of this chapter unless the board determines that the military training or experience is not substantially equivalent to the standards of this state. [ 2011 c 32 s 8.] RCW 18.74.035 Examinations—Scope—Time and place. (1) All qualified applicants for a license as a physical therapist shall be examined by the board at such time and place as the board may determine. The board may approve an examination prepared or administered by a private testing agency or association of licensing authorities. The examination shall embrace the following subjects: The applied sciences of anatomy, neuroanatomy, kinesiology, physiology, pathology, psychology, physics; physical therapy, as defined in this chapter, applied to medicine, neurology, orthopedics, pediatrics, psychiatry, surgery; medical ethics; technical procedures in the practice of physical therapy as defined in this chapter; and such other subjects as the board may deem useful to test the applicant's fitness to practice physical therapy. Examinations shall be held within the state at least once a year, at such time and place as the board shall determine. An applicant who fails an examination may apply for reexamination upon payment of a reexamination fee determined by the secretary. (2) All qualified applicants for a license as a physical therapist assistant must be examined by the board at such a time and place as the board may determine. The board may approve an examination prepared or administered by a private testing agency or association of licensing authorities. [ 2014 c 116 s 4; 2007 c 98 s 4; 1995 c 198 s 10; 1991 c 3 s 176; 1983 c 116 s 7; 1961 c 64 s 3.] NOTES: Effective date— RCW 18.74.038 Physical therapist assistants—Waiver of examination. The board shall waive the examination and grant a license to a person who meets the commonly accepted standards for practicing as a physical therapist assistant, as adopted by rule. Persons eligible for licensure as a physical therapist assistant under this section must apply for a license within one year of July 1, 2008. [ 2007 c 98 s 7.] RCW 18.74.040 Licenses. (1) The secretary shall license as a physical therapist, and shall furnish a license to, each applicant who successfully passes the examination for licensure as a physical therapist. (2) The secretary shall license as a physical therapist assistant, and shall furnish a license to, each applicant who successfully passes the examination for licensure as a physical therapist assistant. [ 2007 c 98 s 5; 1991 c 3 s 177; 1983 c 116 s 8; 1949 c 239 s 4; Rem. Supp. 1949 s 10163-4.] RCW 18.74.050 Licenses—Fees. (1) The secretary shall furnish a license upon the authority of the board to any person who applies and who has qualified under the provisions of this chapter. At the time of applying, the applicant shall comply with administrative procedures, administrative requirements, and fees established pursuant to RCW 43.70.250 and 43.70.280. No person registered or licensed on July 24, 1983, as a physical therapist shall be required to pay an additional fee for a license under this chapter. (2) No fees collected pursuant to subsection (1) of this section may be used to meet the state's monetary obligations as a member state to the physical therapy licensure compact. [ 2017 c 108 s 4; 1996 c 191 s 59; 1991 c 3 s 178; 1985 c 7 s 63; 1983 c 116 s 9; 1975 1st ex.s. c 30 s 65; 1961 c 64 s 4; 1949 c 239 s 5; Rem. Supp. 1949 s 10163-5.] RCW 18.74.060 Licensure by endorsement. Upon the recommendation of the board, the secretary shall license as a physical therapist or physical therapist assistant and shall furnish a license to any person who is a physical therapist or physical therapist assistant registered, certified, or licensed under the laws of another state or territory, or the District of Columbia, if the qualifications for such registration, certification, or license required of the applicant were substantially equal to the requirements under this chapter. At the time of making application, the applicant shall comply with administrative procedures, administrative requirements, and fees established pursuant to RCW 43.70.250 and 43.70.280. [ 2007 c 98 s 6; 1996 c 191 s 60; 1991 c 3 s 179; 1985 c 7 s 64; 1983 c 116 s 10; 1975 1st ex.s. c 30 s 66; 1961 c 64 s 5; 1949 c 239 s 6; Rem. Supp. 1949 s 10163-6.] RCW 18.74.065 Licenses—Issuance to persons licensed or registered before July 24, 1983. Any person holding a valid license or certificate of registration to practice physical therapy issued by authority of this state prior to July 24, 1983, shall be issued a license under this chapter. [ 1983 c 116 s 11.] RCW 18.74.070 Renewal of license. Every licensed physical therapist and physical therapist assistant shall apply to the secretary for a renewal of the license and pay to the state treasurer a fee determined by the secretary as provided in RCW 43.70.250 and 43.70.280. [ 2007 c 98 s 8; 1996 c 191 s 61; 1991 c 3 s 180; 1983 c 116 s 12; 1975 1st ex.s. c 30 s 67; 1971 ex.s. c 266 s 13; 1961 c 64 s 6; 1949 c 239 s 7; Rem. Supp. 1949 s 10163-7.] RCW 18.74.073 Licenses—Inactive status—Fees. Any physical therapist or physical therapist assistant licensed under this chapter not practicing physical therapy or providing services may place his or her license in an inactive status. The board shall prescribe requirements for maintaining an inactive status and converting from an inactive or active status. The secretary may establish fees for alterations in license status. [ 2007 c 98 s 9; 1998 c 143 s 1.] RCW 18.74.075 Interim permits. (1) The department, upon approval by the board, shall issue an interim permit authorizing an applicant for licensure who meets the minimum qualifications stated in RCW 18.74.030 to practice physical therapy under graduate supervision pending notification of the results of the first licensure examination for which the applicant is eligible, but not to exceed six months. (2) For purposes of this section, "graduate supervision" means supervision of a holder of an interim permit by a licensed physical therapist who is on the premises at all times. Graduate supervision shall include consultation regarding evaluation, treatment plan, treatment program, and progress of each assigned patient at appropriate intervals and be documented by cosignature of notes by the licensed physical therapist. RCW 18.74.012 is not applicable for holders of interim permits. (3) If the holder of the interim permit fails the examination, the permit expires upon notification and is not renewable. [ 1993 c 133 s 1.] RCW 18.74.085 Types of advertising prohibited. (1) Physical therapists shall not advertise that they perform spinal manipulation, manipulative mobilization of the spine, chiropractic adjustment, spinal adjustment, maintenance or wellness manipulation, or chiropractic care of any kind. (2) A violation of this section is unprofessional conduct under this chapter and chapter 18.130 RCW. [ 2014 c 116 s 5; 1988 c 185 s 4.] NOTES: Effective date— RCW 18.74.090 False advertising—Use of name and words—License required—Prosecutions of violations. (1) A person who is not licensed with the secretary of health as a physical therapist under the requirements of this chapter shall not represent him or herself as being so licensed and shall not use in connection with his or her name the words or letters "P.T.", "R.P.T.", "L.P.T.", "physical therapy", "physiotherapy", "physical therapist" or "physiotherapist", or any other letters, words, signs, numbers, or insignia indicating or implying that he or she is a physical therapist. No person may practice physical therapy without first having a valid license. Nothing in this chapter prohibits any person licensed in this state under any other act from engaging in the practice for which he or she is licensed. It shall be the duty of the prosecuting attorney of each county to prosecute all cases involving a violation of this chapter arising within his or her county. The attorney general may assist in such prosecution and shall appear at all hearings when requested to do so by the board. (2) No person assisting in the practice of physical therapy may use the title "physical therapist assistant," the letters "PTA," or any other words, abbreviations, or insignia in connection with his or her name to indicate or imply, directly or indirectly, that he or she is a physical therapist assistant without being licensed in accordance with this chapter as a physical therapist assistant. (3) Subsections (1) and (2) of this section do not apply to an individual who is authorized to practice as a physical therapist or work as a physical therapist assistant by compact privilege as defined in RCW 18.74.500. [ 2017 c 108 s 5; 2007 c 98 s 10; 1991 c 3 s 181; 1987 c 150 s 48; 1986 c 259 s 125; 1983 c 116 s 18; 1961 c 64 s 8; 1949 c 239 s 9; Rem. Supp. 1949 s 10163-9.] NOTES: Severability— RCW 18.74.095 False advertising—Injunctions. If any person violates the provisions of this chapter, the attorney general, prosecuting attorney, the secretary, the board, or any citizen of the same county, may maintain an action in the name of the state to enjoin such person from practicing or holding himself or herself out as practicing physical therapy. The injunction shall not relieve criminal prosecution but the remedy by injunction shall be in addition to the liability of such offender for criminal prosecution and the suspension or revocation of his or her license. [ 1991 c 3 s 182; 1983 c 116 s 19; 1961 c 64 s 9.] RCW 18.74.120 Record of proceedings—Register. The secretary of health shall keep a record of proceedings under this chapter and a register of all persons licensed under it. The register shall show the name of every living licensed physical therapist and physical therapist assistant, his or her last known place of residence, and the date and number of his or her license as a physical therapist or physical therapist assistant. [ 2007 c 98 s 11; 1991 c 3 s 183; 1983 c 116 s 21; 1979 c 158 s 63; 1977 c 75 s 11; 1949 c 239 s 12; Rem. Supp. 1949 s 10163-12.] RCW 18.74.125 Construction of chapter—Activities not prohibited—Use of letters or words in connection with name. Nothing in this chapter shall prohibit any person licensed in this state under any other act from engaging in the practice for which he or she is licensed. Nothing in this chapter shall prohibit any person who, at any time prior to January 1, 1961, was practicing any healing or manipulative art in the state of Washington and designating the same as physical therapy or physiotherapy, from continuing to do so after the passage of this amendatory act: PROVIDED, That no such person shall represent himself or herself as being registered and shall not use in connection with his or her name the words or letters "registered" or "licensed" or "R.P.T." [ 2011 c 336 s 498; 1961 c 64 s 10.] NOTES: Reviser's note: RCW 18.74.128 Construction of chapter—Health carrier contracts with physical therapist assistants. Nothing in this chapter may be construed to require that a health carrier defined in RCW 48.43.005 contract with a person licensed as a physical therapist assistant under this chapter. [ 2007 c 98 s 17.] RCW 18.74.130 Exemptions. This chapter does not prohibit or regulate: (1) The practice of physical therapy by students enrolled in approved schools as may be incidental to their course of study so long as such activities do not go beyond the scope of practice defined by this chapter. (2) Auxiliary services provided by physical therapy aides carrying out duties necessary for the support of physical therapy including those duties which involve minor physical therapy services when performed under the direct supervision of licensed physical therapists so long as such activities do not go beyond the scope of practice defined by this chapter. (3) The practice of physical therapy by licensed or registered physical therapists of other states or countries while appearing as clinicians of bona fide educational seminars sponsored by physical therapy, medical, or other healing art professional associations so long as such activities do not go beyond the scope of practice defined by this chapter. (4) The practice of physical therapists and physical therapist assistants in the armed services or employed by any other branch of the federal government. [ 2007 c 98 s 12; 1983 c 116 s 22.] RCW 18.74.135 Insurance coverage and benefits not required or regulated. This chapter shall not be construed to restrict the ability of any insurance entity regulated by Title 48 RCW, or any state agency or program from limiting or controlling the utilization of physical therapy services by the use of any type of gatekeeper function; nor shall it be construed to require or prohibit that individual or group policies or contracts of an insurance carrier, health care service contractor, or health maintenance organization provide benefits or coverage for services and supplies provided by a person licensed under this chapter. For the purpose of this chapter, "gatekeeper function" means any provision in a contract which establishes a threshold requirement, such as a recommendation from a case manager or a primary care provider, which must be satisfied before a covered person is eligible to receive benefits under the contract. [ 1988 c 185 s 5.] RCW 18.74.140 Practice setting not restricted. Nothing in this chapter restricts the ability of physical therapists to work in the practice setting of their choice. [ 1991 c 12 s 4.] RCW 18.74.150 Unlawful activities—Persons exempt from licensure under chapter. (1) It is unlawful for any person to practice or in any manner hold himself or herself out to practice physical therapy or designate himself or herself as a physical therapist or physical therapist assistant, unless he or she is licensed in accordance with this chapter or has unencumbered compact privilege as defined in RCW 18.74.500. (2) This chapter does not restrict persons licensed under any other law of this state from engaging in the profession or practice for which they are licensed, if they are not representing themselves to be physical therapists, physical therapist assistants, or providers of physical therapy. (3) The following persons are exempt from licensure as physical therapists under this chapter when engaged in the following activities: (a) A person who is pursuing a course of study leading to a degree as a physical therapist in an approved professional education program and is satisfying supervised clinical education requirements related to his or her physical therapy education while under direct supervision of a licensed physical therapist; (b) A physical therapist while practicing in the United States armed services, United States public health service, or veterans administration as based on requirements under federal regulations for state licensure of health care providers; and (c) A physical therapist licensed in another United States jurisdiction, or a foreign-educated physical therapist credentialed in another country, performing physical therapy as part of teaching or participating in an educational seminar of no more than sixty days in a calendar year. (4) The following persons are exempt from licensure as physical therapist assistants under this chapter when engaged in the following activities: (a) A person who is pursuing a course of study leading to a degree as a physical therapist assistant in an approved professional education program and is satisfying supervised clinical education requirements related to his or her physical therapist assistant education while under direct supervision of a licensed physical therapist or licensed physical therapist assistant; (b) A physical therapist assistant while practicing in the United States armed services, United States public health service, or veterans administration as based on requirements under federal regulations for state licensure of health care providers; and (c) A physical therapist assistant licensed in another United States jurisdiction, or a foreign-educated physical therapist assistant credentialed in another country, or a physical therapist assistant who is teaching or participating in an educational seminar of no more than sixty days in a calendar year. [ 2017 c 108 s 6; 2013 c 280 s 1; 2007 c 98 s 13; 2005 c 501 s 4.] RCW 18.74.160 Authorization to practice—Referral to appropriate practitioner—Standards of ethics—Electroneuromyographic examinations—Authorization to purchase, store, and administer certain drugs or medication. (1) A physical therapist licensed under this chapter is fully authorized to practice physical therapy as defined in this chapter. (2) A physical therapist shall refer persons under his or her care to appropriate health care practitioners if the physical therapist has reasonable cause to believe symptoms or conditions are present that require services beyond the scope of practice under this chapter or when physical therapy is contraindicated. (3) Physical therapists and physical therapist assistants shall adhere to the recognized standards of ethics of the physical therapy profession and as further established by rule. (4) A physical therapist may perform electroneuromyographic examinations for the purpose of testing neuromuscular function only by referral from an authorized health care practitioner identified in *RCW 18.74.010(7) and only upon demonstration of further education and training in electroneuromyographic examinations as established by rule. Within two years after July 1, 2005, the secretary shall waive the requirement for further education and training for those physical therapists licensed under this chapter who perform electroneuromyographic examinations. (5) A physical therapist licensed under this chapter may purchase, store, and administer medications such as hydrocortisone, fluocinonide, topical anesthetics, silver sulfadiazine, lidocaine, magnesium sulfate, zinc oxide, and other similar medications, and may administer such other drugs or medications as prescribed by an authorized health care practitioner for the practice of physical therapy. A pharmacist who dispenses such drugs to a licensed physical therapist is not liable for any adverse reactions caused by any method of use by the physical therapist. [ 2007 c 98 s 14; 2005 c 501 s 5.] NOTES: *Reviser's note: RCW 18.74.170 Delegation. (1) Physical therapists are responsible for patient care given by assistive personnel under their supervision. A physical therapist may delegate to assistive personnel and supervise selected acts, tasks, or procedures that fall within the scope of physical therapy practice but do not exceed the education or training of the assistive personnel. (2) Nothing in this chapter may be construed to prohibit other licensed health care providers from using the services of physical therapist assistants, as long as the title "physical therapist assistant" is not used in violation of RCW 18.74.090, physical therapist aides, or other assistive personnel as long as the licensed health care provider is responsible for the activities of such assistants, aides, and other personnel and provides appropriate supervision. [ 2007 c 98 s 15; 2005 c 501 s 6.] RCW 18.74.180 Professional and legal responsibility—Supervision of assistive personnel. A physical therapist is professionally and legally responsible for patient care given by assistive personnel under his or her supervision. If a physical therapist fails to adequately supervise patient care given by assistive personnel, the board may take disciplinary action against the physical therapist. (1) Regardless of the setting in which physical therapy services are provided, only the licensed physical therapist may perform the following responsibilities: (a) Interpretation of referrals; (b) Initial examination, problem identification, and diagnosis for physical therapy; (c) Development or modification of a plan of care that is based on the initial examination and includes the goals for physical therapy intervention; (d) Determination of which tasks require the expertise and decision-making capacity of the physical therapist and must be personally rendered by the physical therapist, and which tasks may be delegated; (e) Assurance of the qualifications of all assistive personnel to perform assigned tasks through written documentation of their education or training that is maintained and available at all times; (f) Delegation and instruction of the services to be rendered by the physical therapist, physical therapist assistant, other assistive personnel, or physical therapy aide including, but not limited to, specific tasks or procedures, precautions, special problems, and contraindicated procedures; (g) Timely review of documentation, reexamination of the patient, and revision of the plan of care when indicated; (h) Establishment of a discharge plan. (2) If patient care is given by a physical therapist assistant, or other assistive personnel, supervision by the physical therapist requires that the patient reevaluation is performed: (a) The later of every fifth visit or every thirty days if a physical therapist has not treated the patient for any of the five visits or within the thirty days; (b) When there is any change in the patient's condition not consistent with planned progress or treatment goals. (3) Supervision of assistive personnel means: (a) Physical therapist assistants may function under direct or indirect supervision; (b) Physical therapy aides must function under direct supervision at all times. Other assistive personnel must function under direct supervision when treating a patient under a physical therapy plan of care; (c)(i) Except as provided in (c)(ii) of this subsection, at any one time, the physical therapist may supervise up to a total of three assistive personnel, who may be physical therapist assistants, other assistive personnel, or physical therapy aides. If the physical therapist is supervising the maximum of three assistive personnel at any one time, no more than one of the assistive personnel may be a physical therapy aide. The physical therapist has the sole discretion, based on the physical therapist's clinical judgment, to determine whether to utilize assistive personnel to provide services to a patient. (ii) A physical therapist working in a nursing home as defined in RCW 18.51.010 or in the public schools as defined in RCW 28A.150.010, may supervise a total of only two assistive personnel at any one time. (iii) In addition to the assistive personnel authorized in (c)(i) and (ii) of this subsection, the physical therapist may supervise a total of two persons who are pursuing a course of study leading to a degree as a physical therapist or a physical therapist assistant. [ 2018 c 222 s 2; 2013 c 280 s 2; 2007 c 98 s 16.] RCW 18.74.190 Spinal manipulation—Endorsement. (1) Subject to the limitations of this section, a physical therapist may perform spinal manipulation only after being issued a spinal manipulation endorsement by the secretary. The secretary, upon approval by the board, shall issue an endorsement to a physical therapist who has at least one year of full-time, orthopedic, postgraduate practice experience that consists of direct patient care and averages at least thirty-six hours a week and who provides evidence in a manner acceptable to the board of all of the following additional requirements: (a) Training in differential diagnosis of no less than one hundred hours outlined within a course curriculum; (b) Didactic and practical training related to the delivery of spinal manipulative procedures of no less than two hundred fifty hours clearly delineated and outlined in a course curriculum; (c) Specific training in spinal diagnostic imaging of no less than one hundred fifty hours outlined in a course curriculum; and (d) At least three hundred hours of supervised clinical practical experience in spinal manipulative procedures. The supervised clinical practical experience must: (i) Be supervised by a clinical supervisor who: (A) Holds a spinal manipulation endorsement under this section; or (B) Is a licensed chiropractor or osteopathic physician and surgeon; (ii) Be under the close supervision of the clinical supervisor for a minimum of the first one hundred fifty hours of the supervised clinical practical experience, after which the supervised clinical practical experience must be under the direct supervision of the clinical supervisor; (iii) Be completed within eighteen months of completing the educational requirements in (a) through (c) of this subsection, unless the physical therapist has completed the educational requirements in (a) through (c) of this subsection prior to July 1, 2015, in which case the supervised clinical practical experience must be completed by January 1, 2017. (2) A physical therapist holding a spinal manipulation endorsement under subsection (1) of this section shall consult with a health care practitioner, other than a physical therapist, authorized to perform spinal manipulation if spinal manipulative procedures are required beyond six treatments. (3) A physical therapist holding a spinal manipulation endorsement under subsection (1) of this section may not: (a) Have a practice in which spinal manipulation constitutes the majority of the services provided; (b) Practice or utilize chiropractic manipulative therapy in any form; (c) Delegate spinal manipulation; or (d) Bill a health carrier for spinal manipulation separately from, or in addition to, other physical therapy procedures. (4) A physical therapist holding a spinal manipulation endorsement under this section shall complete at least ten hours of continuing education per continuing competency reporting period directly related to spinal manipulation. At least five hours of the training required under this subsection must be related to procedural technique and application of spinal manipulation. (5) If a physical therapist is intending to perform spinal manipulation on a patient who the physical therapist knows is being treated by a chiropractor for the same diagnosis, the physical therapist shall make reasonable efforts to coordinate patient care with the chiropractor to prevent conflict or duplication of services. (6) By November 15, 2019, the board shall report to the legislature any disciplinary actions taken against physical therapists whose performance of spinal manipulation and manipulative mobilization of the spine and its immediate articulations resulted in physical harm to a patient. Prior to finalizing the report required under this subsection, the board shall consult with the chiropractic quality assurance commission. [ 2014 c 116 s 2; 2014 c 116 s 1.] NOTES: Effective date— RCW 18.74.200 Intramuscular needling—Endorsement. (Effective until June 30, 2027.) (1) Subject to the limitations of this section, a physical therapist may perform intramuscular needling only after being issued an intramuscular needling endorsement by the secretary. The secretary, upon approval by the board, shall issue an endorsement to a physical therapist who has at least one year of postgraduate practice experience that averages at least 36 hours a week and consists of direct patient care and who provides evidence in a manner acceptable to the board of a total of 325 hours of instruction and clinical experience that meet or exceed the following criteria: (a) A total of 100 hours of didactic instruction in the following areas: (i) Anatomy and physiology of the musculoskeletal and neuromuscular systems; (ii) Anatomical basis of pain mechanisms, chronic pain, and referred pain; (iii) Trigger point evaluation and management; (iv) Universal precautions in avoiding contact with a patient's bodily fluids; and (v) Preparedness and response to unexpected events including but not limited to injury to blood vessels, nerves, and organs, and psychological effects or complications. (b) A total of 75 hours of in-person intramuscular needling instruction in the following areas: (i) Intramuscular needling technique; (ii) Intramuscular needling indications and contraindications; (iii) Documentation and informed consent for intramuscular needling; (iv) Management of adverse effects; (v) Practical psychomotor competency; and (vi) Occupational safety and health administration's blood-borne pathogens protocol. (c) A successful clinical review of a minimum of 150 hours of at least 150 individual intramuscular needling treatment sessions by a qualified provider. A physical therapist seeking endorsement must submit an affidavit to the department demonstrating successful completion of this clinical review. (2) A qualified provider must be one of the following: (a) A physician licensed under chapter 18.71 RCW; an osteopathic physician licensed under chapter 18.57 RCW; a licensed naturopath under chapter 18.36A RCW; a licensed acupuncture and Eastern medicine practitioner under chapter 18.06 RCW; or a licensed *advanced registered nurse practitioner under chapter 18.79 RCW; (b) A physical therapist credentialed to perform intramuscular needling in any branch of the United States armed forces; (c) A licensed physical therapist who currently holds an intramuscular needling endorsement; or (d) A licensed physical therapist who meets the requirements of the intramuscular needling endorsement. (3) After receiving 100 hours of didactic instruction and 75 hours of in-person intramuscular needling instruction, a physical therapist seeking endorsement has up to 18 months to complete a minimum of 150 treatment sessions for review. (4) A physical therapist may not delegate intramuscular needling and must remain in constant attendance of the patient for the entirety of the procedure. (5) A physical therapist can apply for endorsement before they have one year of clinical practice experience if they can meet the requirement of 100 hours of didactic instruction and 75 hours of in-person intramuscular needling instruction in subsection (1)(a)(i) and (ii) of this section through their prelicensure coursework and has completed all other requirements set forth in this chapter. (6) If a physical therapist is intending to perform intramuscular needling on a patient who the physical therapist knows is being treated by an acupuncturist or acupuncture and Eastern medicine practitioner for the same diagnosis, the physical therapist shall make reasonable efforts to coordinate patient care with the acupuncturist or acupuncture and Eastern medicine practitioner to prevent conflict or duplication of services. (7) All patients receiving intramuscular needling from a physical therapist must sign an informed consent form that includes: (a) The definition of intramuscular needling; (b) A description of the risks of intramuscular needling; (c) A description of the benefits of intramuscular needling; (d) A description of the potential side effects of intramuscular needling; and (e) A statement clearly differentiating the procedure from the practice of acupuncture. (8) Intramuscular needling may not be administered as a stand-alone treatment within a physical therapy care plan. [ 2023 c 198 s 2.] NOTES: *Reviser's note: RCW 18.74.500 Physical Therapy Licensure Compact. The Physical Therapy Licensure Compact as set forth in this section is hereby enacted into law and entered into on behalf of this state with any and all other states legally joining therein in a form substantially as follows: PHYSICAL THERAPY LICENSURE COMPACT RCW 18.74.510 Physical therapy licensure compact—Compact privilege—Fees. (1) The secretary, in consultation with the board, shall establish fees pursuant to RCW 43.70.250 for physical therapists and physical therapist assistants seeking to practice in this state by use of compact privilege as defined in RCW 18.74.500. At the time of applying for compact privilege in this state, the applicant shall comply with established fee requirements. (2) The fees established in subsection (1) of this section must be an amount sufficient to cover the state's monetary obligations as a member state to the physical therapy licensure compact. [ 2017 c 108 s 2.] NOTES: Short title— RCW 18.74.520 Physical therapy licensure compact—Criminal history information. The board shall not disseminate any criminal history information gained through a federal background check, ordered pursuant to RCW 18.74.500, the physical therapy licensure compact, to the physical therapy compact commission or another state or state licensure board. [ 2017 c 108 s 3.] RCW 18.74.912 Effective dates—2007 c 98. (1) Sections 1 and 3 through 18 of this act take effect July 1, 2008. (2) Section 2 of this act takes effect December 1, 2008. [ 2007 c 98 s 19.]