Texas Board of Physical Therapy Examiners
For a copy of all sections of the PT Rules,
go to http://www.ptot.texas.gov
CHAPTER 322. PRACTICE
§322.1. Provision of Services.
(a) Initiation of physical therapy services.
(1) Referral requirement. A physical therapist is subject to discipline from the board for
providing physical therapy treatment without a referral from a qualified healthcare practitioner
licensed by the appropriate licensing board, who within the scope of the professional licensure
is authorized to prescribe treatment of individuals. The list of qualifying referral sources includes
physicians, dentists, chiropractors, podiatrists, physician assistants, and advanced nurse
(2) Exceptions to referral requirement.
(A) A PT may evaluate without referral.
(B) A PT may provide instructions to any person who is asymptomatic relating to the
instructions being given without a referral, including instruction to promote health,
wellness, and fitness.
(C) Emergency Circumstances. A PT may provide emergency medical care to a person
after the sudden onset of a medical condition manifesting itself by acute symptoms of
sufficient severity without referral if the absence of immediate medical attention could
reasonably be expected to result in a serious threat to the patient's health, serious
impairment to bodily functions, or serious dysfunction of any bodily organ or part.
(D) Prior referrals. A physical therapist may treat a patient for an injury or condition that
is the subject of a prior referral if all of the following conditions are met.
(i) The physical therapist must notify the original referring healthcare personnel
of the commencement of therapy by telephone within five days, or by letter
postmarked within five business days;
(ii) The physical therapy provided must not be for more than 20 treatment
sessions or 30 consecutive calendar days, whichever occurs first. At the
conclusion of this time or treatment, the physical therapist must confer with the
referring healthcare personnel before continuing treatment;
(iii) The treatment can only be provided to a client/patient who received the
referral not more than one year previously; and
(iv) The physical therapist providing treatment must have been licensed for one
year. The physical therapist responsible for the treatment of the patient may
delegate appropriate duties to another physical therapist having less than one
year of experience or to a physical therapist assistant. A physical therapist
licensed for more than one year must retain responsibility for and supervision of
(3) Methods of referral. A referral may be transmitted by a qualifying referral source in the
(A) in a written document, including faxed and emailed documents; or
(B) verbally, in person or by telephone. If a referral is transmitted verbally, whether in
person or by telephone, it must be received, recorded and signed by the PT, PTA or
other authorized personnel, and include all of the information that would appear on a
(b) Evaluation and screening.
(1) Evaluation. Physical therapy treatment may not be provided prior to the completion of an
evaluation of the patient's condition by a PT.
(2) PTAs may screen patients designated by a PT as possible candidates for physical therapy
services. Screening entails the collection of uniform information from all patients screened using
a predetermined, standardized format. The information collected is delivered to the supervising
PT. Only a PT may determine whether further intervention for patients screened is necessary.
(c) Physical therapy plan of care development and implementation.
(1) The PT must develop a written plan of care, based on his evaluation, for each patient.
(2) Treatment may not be provided by a PTA or aide until the plan of care has been established.
(3) The plan of care must be reviewed and updated as necessary following a reevaluation of the
(4) The plan of care or treatment goals may only be changed or modified by a PT.
(5) A PTA may modify treatment techniques as indicated in the plan of care.
(6) A PT or PTA must interact with the patient regarding his/her condition, progress and/or
achievement of goals during each treatment session.
(1) A patient receiving treatment must be reevaluated by a PT:
(A) at a minimum of once every 30 days after treatment is initiated, or at a higher
frequency as established by the PT; and
(B) In response to a change in the patient's medical status that affects physical therapy
treatment, when a change in the physical therapy plan of care is needed, or prior to any
(2) A reevaluation must include:
(A) An onsite reexamination of the patient; and
(B) A review of the plan of care with appropriate continuation, revision, or termination
(3) Provision of physical therapy treatment by a PTA or an aide may not continue if the PT has
not performed the required reevaluation.
(e) Documentation of treatment.
(1) At a minimum, documentation of physical therapy services must include the following:
(A) any referral authorizing treatment;
(B) the initial examination and evaluation;
(C) the plan of care;
(D) documentation of each treatment session by the PT or PTA providing the services;
(E) reevaluations as required by this section;
(F) any conferences between the PT and PTA, as described in this section; and
(G) the discharge summary.
(2) The PTA must include the name of the supervising PT in his documentation of each
(3) Physical therapy aides may not write or sign any physical therapy documents in the
permanent record. However, a physical therapy aide may enter quantitative data for tasks
delegated by the supervising PT or PTA.
(4) Discharge Summary. The PT must provide final documentation for discharge of a patient,
including patient response to treatment at the time of discharge and any necessary follow-up
plan. A PTA may participate in the discharge summary by providing subjective and objective
patient information to the supervising physical therapist.
Source Note: The provisions of this §322.1 adopted to be effective April 15, 1999, 24 TexReg 2935;
amended to be effective November 19, 2001, 26 TexReg 9382; amended to be effective September 18,
2006, 31 TexReg 7998; amended to be effective February 18, 2008, 33 TexReg 1335; amended to be
effective April 4, 2011, 36 TexReg 2124.
CHAPTER 346. PRACTICE SETTINGS FOR PHYSICAL THERAPY
§346.1. Educational Settings.
(a) In the educational setting, the physical therapist conducts appropriate screenings, evaluations, and
assessments to determine needed services to fulfill educational goals. When a student is determined
by the physical therapist to be eligible for physical therapy as a related service defined by Special
Education Law, the physical therapist provides written recommendations to the Admissions Review and
Dismissal Committee as to the amount of specific services needed by the student (i.e., consultation or
direct services and the frequency and duration of services).
(b) The physical therapist implements physical therapy services in accordance with the
recommendations accepted by the school committee members and as reflected in the student's
Admission Review and Dismissal Committee reports.
(c) The physical therapist may provide general consultation or other physical therapy program services
for school administrators, educators, assistants, parents and others to address district, campus,
classroom or student-centered issues. For the student who is eligible to receive physical therapy as a
related service in accordance with the student's Admission Review and Dismissal Committee reports,
the physical therapist will also provide the consultation and direct types of specific services needed to
implement specially designed goals and objectives included in the student's Individualized Education
(d) The types of services which may require a physician's referral in the educational setting include the
provision of individualized specially designed instructions and the direct physical modeling or hands-on
demonstration of activities with a student who has been determined eligible to receive physical therapy
as a related service. Additionally, they may include the direct provision of activities which are of such a
nature that they are only conducted with the eligible student by a physical therapist or physical
therapist assistant. The physical therapist should refer to §322.1 of this title (relating to Provision of
(e) Evaluation and reevaluation in the educational setting will be conducted in accordance with federal
mandates under Part B of the Individuals with Disabilities Education Act (IDEA), 20 USC §1414, or
when warranted by a change in the child's condition, and include onsite reexamination of the child.
Treatment provided by a PT or PTA is subject to the provisions of §322.1 of this title.
Source Note: The provisions of this §346.3 adopted to be effective October 13, 2002, 27 TexReg 9327;
amended to be effective August 4, 2004, 29 TexReg 7303; amended to be effective March 5, 2007, 32
TexReg 1075; amended to be effective February 13, 2012, 37 TexReg 690.
Texas Board of Physical Therapy Examiners
Rules, June 2012
Executive council of Physical Therapy and Occupational Therapy Examiners
Adopted under the authority of
Title 3, Subtitle H, Chapter 453, Occupations Code
Texas Administrative Code
TBPTE Practice FAQs
How often must a PT re-evaluate a student receiving physical therapy in the school setting?
Although it is not defined in either the Physical Therapy Act or Rules, the use of the term “treatment”
throughout the Act/Rules refers to the sum of all interventions provided by the physical therapist to a
patient/client/student/child during an episode of care.
The provision of physical therapy, regardless of whether a licensee chooses to refer to it as “treatment”
or “ a service”, should comply with the PT Act/Rules, i.e. PT Rules §346.1 (e) “…..Treatment provided by
a PT or PTA is subject to the provisions of §322.1 of this title.”
A re-evaluation, §322.1 (d), should be performed by the Physical Therapist to determine any changes in
the patient’s/student’s status since the last eval/re-eval and to determine whether the planned service
and/or goals should be modified. This should be done at a minimum of once every 30 days or at every
visit if the patient/student is seen less frequently.
Prior to February 13, 2012, PTs were allowed to review the plan of care in lieu of doing a re-evaluation.
After further consideration, the Board amended §346.1 on that date so that re-evaluation is required
for all students receiving physical therapy services.
Clarification of Provision of Physical Therapy in the School Setting
Rules & Practice Committee Meeting, 5.03.12
TX Board of Physical Therapy Examiners Meeting, 5.04.12
Confusion appears to stem from an attempt by physical therapists practicing in a
school setting to superimpose the Occupational Therapy model of medical vs
non-medical conditions over the provision of Physical Therapy. This distinction
does not exist within the Physical Therapy Act or Rules.
Although it is not defined in either the Physical Therapy Act or Rules, the use of
the term “treatment” throughout the Act/Rules refers to the sum of all
interventions provided by the physical therapist to a patient/client/student/child
during an episode of care.
The provision of Physical Therapy, regardless of whether a licensee chooses to
refer to it as “treatment” or “ a service”, should comply with the PT Act/Rules, i.e.
PT Rules §346.1 (e) “…..Treatment provided by a PT or PTA is subject to the
provisions of §322.1 of this title.”
A re-evaluation, §322.1 (d), should be performed by the Physical Therapist to
determine any changes in the patient’s/student’s status since the last eval/re-eval
and to determine whether the planned service and/or goals should be modified.
This should be done at a minimum of once every 30 days or at every visit if the
patient/student is seen less frequently.
It is not within the scope of its authority for the Board to determine whether or not
Physical Therapy can be provided as a supplementary aid or service in the
school setting. If Physical Therapy is provided as either a related or a
supplementary service, the Board’s authority lies in determining whether or not
the service is in compliance with the PT Act/Rules.
Clarification on PT Rule 346.1
Emails from PTs in the Region 4 area to ECPTOTE
Does the proposed 346.1 mean that in the school setting the PT must perform an onsite reevaluation
every 30 days? If so, is there any guidance on how extensive this reevaluation must be?
Answer, Nina Hurter, PT Coordinator, ECPTOTE, 4-2-12:
The last line of that rule is the only thing that changed. And what it means is that now, based on the
type of services a student is getting, you may need to do a hands-on reeval every 30 days, for that
The Board used the word "treatment" to give the PT a way to differentiate between students that need
reevaluation and those that don't. They did not define "treatment" as direct services specifically. They
leave it up to you to decide which students are receiving what you would define as physical therapy
"treatment" and which are receiving services that do not qualify as treatment.
I am a school based physical therapist and I have a question regarding the change to our practice act.
According to 322.1, a re-eval should be performed by the PT to determine any changes in the student's
status since last re-eval and to determine whether the planned service and/or goals should be modified.
This should be done at a minimum of once every 30 days, or at every visit if the student is seen less
My question is, since I am in the school system and I need parent consent to perform an eval or re-eval,
so will I need parent consent every 30 days to perform my re-eval? Or is this simply a re-assessment of
the student's goals and progress that is not really a "re-eval" in the school setting sense. It seems that if I
performing a real re-eval every 30 days and I do not have parent consent then I run the risk of being
taken to court.
Answer, Nina Hurter, PT Coordinator, ECPTOTE, 9-25-12:
“You are correct - in this case, it is a terminology conflict. The Board wants you to "reassess" the
student, using IDEA terminology.”
I am a school based PT and am trying to understand what the changes to rule 346.1 mean to me in the
school setting. I think the main thing I am struggling with is the word “re-evaluation” and what this
would look like for me in this setting. As I’m sure you know, for a re-evaluation in the school setting we
meet with the parents in an ARD meeting to review existing data to determine if additional data is
needed. If the committee determines additional data is needed the consent is obtained from the parents
to test and assessment is planned.
I’m struggling to understand if I needed consent for this 30 day re-evaluation or is it more of a monthly
update? I write a note for every session and typically discuss how a child is doing on what goals and what
we will continue to work on. Could this 30 day re-eval be at the end of a note? Or a checklist? And can we
call it something other than “re-evaluation” to delineate that this is not the regular 3 year re-eval that is
required in schools? Any clarification would be appreciated.
Answer, Nina Hurter, PT Coordinator, ECPTOTE, 9-26-12:
“In the school setting, you can think of it more as a reassessment as defined by IDEA - it is NOT supposed
to be the reevaluation as defined by IDEA which involves the ARD committee. It sounds like you are
currently doing what is required, and you may call it anything you like in the documentation. You can
document it in your notes.”
Nina Hurter, PT Coordinator
Executive Council of PT & OT Examiners
333 Guadalupe, Suite 2-510
Austin, Texas 78701