A nurse is caring for a group of clients. the nurse should plan to make a referral to physical

current medications

ACE inhibitors, beta blockers, theophylline, nifedipine, and glucocorticoids, such as prednisone, that can alter the allergy skin test results. These medications can diminish the client's reaction to the allergens

Practice Alerts

Disclaimer: Practice guidelines provide licensees with general guidance to promote good practice. Law, rules and regulations, not guidelines, specify the requirements for practice and what may constitute professional misconduct.

Alert 1: Referral for Physical Therapy Treatment

A physical therapist (PT) may treat a patient/client after receiving a referral from an authorized health care provider (physician, nurse practitioner, podiatrist, dentist or midwife) licensed and currently registered to practice in New York State. Education Law allows a physician licensed in a bordering state and who resides near the border of New York to practice in New York State without being licensed. This has been interpreted to allow a physician who lives within 25 miles of the New York State border to prescribe physical therapy treatment for a patient/client in New York. This exemption does not extend to any other professionals authorized to issue referrals for physical therapy.

A physician assistant (PA) may order physical therapy services, since the PA is acting as the agent of a licensed physician. However, it is important to know insurance company requirements regarding signatures, since some may not reimburse for treatment unless a physician or other licensed health care provider identified in law signs the referral.

A PT with the equivalent of three years of full-time experience practicing physical therapy may treat without a referral for 10 visits or 30 days, whichever comes first. A PT providing such treatment without referral must provide the patient/client with a written Notice of Advice, indicating that treatment without a referral may not be covered by the patient/client's health care plan or insurer but that it may be covered if provided pursuant to a valid referral. This Notice of Advice must be provided on a form, a copy of which must be kept on file by the licensed PT as a patient/client record and a copy of which must be given to the patient/client. The Notice of Advice must include the following information:

• a statement of such advice and a statement attesting that the patient/client read the Notice of Advice;
• the date treatment will begin;
• the patient/client's name and address;
• the patient/client's signature and date the patient/client signed the form;
• the treating PT's name and address; and
• the treating PT's signature and the date the PT signed the form.

Education Law is silent as to the length of time for which a referral is valid. For more on this issue, see Practice Alert 2.

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Citations of Pertinent Law, Rules or Regulations:
Education Law, Section 6509 – definition of professional misconduct
Education Law, Section 6526(2) – exempt persons with respect to the practice of medicine
Education Law, Section 6731 – definition of physical therapy practice
Regulations of the Commissioner, Section 77.9 – providing treatment in the practice of physical therapy without referral