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2020 Tennessee Code
Title 63 - Professions of the Healing Arts
Chapter 13 - Occupational and Physical Therapy Practice Act
Part 3 - Licensure of Physical Therapists and Assistants
§ 63-13-303. Exceptions to Referral Requirements

Universal Citation: TN Code § 63-13-303 (2020)
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  1. The practice of physical therapy must be under the written or oral referral of a referring practitioner who is a licensed doctor of medicine, chiropractic, dentistry, podiatry, or osteopathy, except a licensed physical therapist may:
    1. Conduct an initial patient visit without referral;
    2. Provide physical assessments or instructions, including a recommendation of exercise to an asymptomatic person, without the referral of a referring practitioner;
      1. In emergency circumstances, including minor emergencies, provide assistance to a person to the best of a physical therapist's ability without the referral of a referring practitioner. Except as provided in subdivision (a)(4), the physical therapist shall refer the person to the appropriate healthcare practitioner, as indicated, immediately after providing assistance;
      2. For the purposes of subdivision (a)(3)(A):
        1. “Emergency circumstances” means instances where emergency medical care is required; and
        2. “Emergency medical care” means bona fide emergency services provided after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to result in:
          1. Placing the patient's health in serious jeopardy;
          2. Serious impairment to bodily functions; or
          3. Serious dysfunction of any bodily organ or part; and
    4. Treat a patient without a referral when, within the scope of practice of physical therapy, the following are met:
      1. The patient's physician, as defined in § 63-6-204(f)(7) has been notified;
      2. If the physical therapist determines, based on clinical evidence, that no progress has been made with respect to that patient's condition within thirty (30) days, immediately following the date of the patient's initial visit with the physical therapist, then the physical therapist shall not provide any additional physical therapy services and shall refer the patient to a healthcare practitioner who qualifies as a referring practitioner;
      3. Physical therapy services must not continue beyond ninety (90) days without consulting with the patient's appropriate healthcare practitioner;
      4. If the patient was previously diagnosed by a licensed physician with chronic, neuromuscular, or developmental conditions, and the evaluation, treatment, or services are being provided for problems or symptoms associated with one (1) or more of those previously diagnosed conditions, then subdivisions (a)(4)(B) and (a)(4)(C) do not apply; and
      5. A physical therapist shall refer patients under the physical therapist's care to appropriate healthcare practitioners, if, at any time, the physical therapist has reasonable cause to believe symptoms or conditions are present that require services beyond the scope of practice of a physical therapist, reasonable therapeutic progress is not being achieved for the patient, or physical therapy treatment is contraindicated.
  2. No person shall practice physical therapy other than upon the referral of a patient by a person who is licensed in this or another state to practice medicine, chiropractic, dentistry, osteopathic medicine or podiatric medicine, within the scope of those practices, and whose license is in good standing and who holds a CPR certificate or its equivalent, unless one of the following conditions is met:
    1. The person holds a master's or doctorate degree from a professional physical therapy program that is accredited by a national accreditation agency recognized by the United States department of education and by the board of physical therapy and the person has completed at least one (1) year of experience as a licensed physical therapist;
    2. The person has successfully completed a residency or clinical fellowship in physical therapy at a program approved by the board; or
      1. The person has completed at least three (3) years of experience as a licensed physical therapist; and
      2. The person has completed a course approved by the board of physical therapy and offered by an accredited university of at least fifteen (15) hours, designed to enable the physical therapist to identify signs and symptoms of systemic disease, particularly those that can mimic cardiological, neurological, oncological or musculoskeletal disorders and to recognize conditions that require timely referral to a physician, dentist, osteopath, podiatrist or chiropractor.
  3. It is unprofessional conduct, for the purposes of § 63-13-312, for a physical therapist to knowingly initiate services to a patient in violation of subdivision (a)(4).
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