PLEASE READ
RulesandregulationsoftheNewJerseyDivisionofConsumerAffairs(Division),the
boardsandcommitteesin,andotherunitsof,theDivisionarecodifiedinTitle13of
theNewJerseyAdministrativeCode,publishedbyLexisNexis.Noticesofproposal
andnoticesofadoptionareprintedintheNewJerseyRegister,alsopublishedby
LexisNexis.Theofficialtextoftherulesandregulationsandtheirregulatoryhistory
andnoticesofruleproposalsandadoptionscanbefoundthroughLexisNexis.
LexisNexis:https://www.lexisnexis.com/en‐us/gateway.page
The text of rules and regulations and notices of proposal and adoptions in PDF
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maydifferfromtheofficialtext.Thougheveryeffortismadetoensurethatthetext
of courtesy copies is identical to the official version, if any discrepancies exist
betweenthetext on this website and the official version, theofficialversionwill
govern.
STATEBOARDOFCHIROPRACTICEXAMINERS LAWANDPUBLICSAFETY
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N EWJ ERSEYA DMINISTRATIVEC ODE
T ITLE13
L AWANDP UBLICS AFETY
C HAPTER44E
S TATEB OARDOFC HIROPRACTIC
E XAMINERS
STATEBOARDOFCHIROPRACTICEXAMINERS LAWANDPUBLICSAFETY
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CHAPTERTABLEOFCONTENTS
SUBCHAPTER1.PURPOSEANDSCOPE;DEFINITIONS...............................................................4
13:44E‐1.1Scopeofpractice........................................................................................................................4
13:44E‐1.2Definitions…………………………………………………………………………………………………………………………….6
SUBCHAPTER1A.LICENSURE...................................................................................................6
13:44E‐1A.1Licensingrequirementsforachiropractor...............................................................................6
13:44E‐1A.2Applicationforlicense:chiropractor........................................................................................7
13:44E‐1A.3Applicantslicensedinotherstates...........................................................................................7
13:44E‐1A.4Bienniallicenserenewal;licenseexpiration;reinstatementafterexpiration;inactivestatus;
returnfrominactivestatus...........................................................................................................................8
13:44E‐1A.5Chiropracticcontinuingeducation.........................................................................................10
13:44E‐1A‐6MalpracticeInsurance............................................................................................................18
SUBCHAPTER2.GENERALRULESOFPRACTICE......................................................................19
13:44E‐2.1Advertising................................................................................................................................19
13:44E‐2.2Patientrecords.........................................................................................................................23
13:44E‐2.3Sexualmisconduct....................................................................................................................27
13:44E‐2.4Chiropractorofrecord;feereimbursement.............................................................................30
13:44E‐2.5Feeschedule.............................................................................................................................30
13:44E‐2.6Referralfees..............................................................................................................................31
13:44E‐2.6APatientrecordreview.............................................................................................................31
13:44E‐2.7Delegabletasksorfunctionsofunlicensedassistants.............................................................32
13:44E‐2.7AOrderingofelectro‐therapydevicesforhomeuse................................................................35
13:44E‐2.8Notificationofchangeofaddress;serviceofprocess..............................................................37
13:44E‐2.9Displayoflicense......................................................................................................................38
13:44E‐2.10Righttoahearing...................................................................................................................38
13:44E‐2.11Overutilization;excessivefees...............................................................................................38
13:44E‐2.12Referralofpatientstophysicaltherapists..............................................................................39
13:44E‐2.13Chiropracticexamination.......................................................................................................40
13:44E‐2.14Independentchiropracticexaminations.................................................................................40
13:44E‐2.15Permissiblepracticestructures..............................................................................................41
SUBCHAPTER3.DETERMINATIONSWITHRESPECTTOTHEVALIDITYOFCERTAINDIAGNOSTIC
TESTS,SPECIALREQUIREMENTSFORELECTRODIAGNOSTICTESTSANDOTHERSPECIAL
EXAMINATIONS.....................................................................................................................45
13:44E‐3.1Definitions.................................................................................................................................45
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13:44E‐3.2Recognizeddiagnostictests;permissiblebilling......................................................................47
13:44E‐3.3Referabletests..........................................................................................................................48
13:44E‐3.4Basicpre‐testprerequisitesandstandardsforpatientevaluationapplicabletoelectro‐
diagnostictestsandspecialexaminations..................................................................................................48
13:44E‐3.5Educationalprerequisitesapplicabletoelectrodiagnostictestsandspecialexaminations;
certificaterequirement...............................................................................................................................51
13:44E‐3.6Informedconsent;equipment;preparationforandperformanceoftheelectrodiagnostictest
....................................................................................................................................................................52
13:44E‐3.7Useoftestingassistant.............................................................................................................54
13:44E‐3.8Preparationoftestreport;follow‐up.......................................................................................54
13:44E‐3.9Limitationsonreferrals............................................................................................................56
13:44E‐3.10Fees.........................................................................................................................................57
13:44E‐3.11Applicationofprohibitionsandlimitations............................................................................57
SUBCHAPTER4.LICENSEDCHIROPRACTICASSISTANTS
13:44E‐4.1Purposeandscope;effectivedate……………………………………………………………………………………….57
13:44E‐4.2Definitions………..………………………………………………………………………………………………………………….58
13:44E‐4.3Scopeofpractice………………………………………………………………………………………………………………….58
13:44E‐4.4Licensingrequirements………………………………………………………………………………………………………..59
13:44E‐4.5Licensureeligibility;exceptions……………………………………………………………………………………………59
13:44E‐4.6Educationrequirements………………………………………………………………………………………………………60
13:44E‐4.7Applicationforlicensure……………………………………………………………………………………………………..60
13:44E‐4.8Issuanceoflicenses;licenserenewals………………………………………………………………………………….61
13:44E‐4.9Continuingeducation…………………………………………………………………………………………………………..61
13:44E‐4.10Displayoflicensure……………………………………………………………………………………………………………67
13:44E‐4.11Notificationofchangeofaddress;serviceofprocess…………………………………………………………67
13:44E‐4.12Opportunitytobeheard…………………………………………………………………………………………………..68
13:44E‐4.13Supervision………………………………………………………………………………………………………………………..68
13:44E‐4.14Planofcare;recordkeeping………………………………………………………………………………………………68
13:44E‐4.15Sexualmisconduct…………………………………………………………………………………………………………….69
13:44E‐4.16Feeschedule……………………………………………………………………………………………………………………..70
STATEBOARDOFCHIROPRACTICEXAMINERS LAWANDPUBLICSAFETY
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SUBCHAPTER 1.
PURPOSE AND SCOPE; DEFINITIONS
13:44E-1.1 SCOPE OF PRACTICE
a) The practice of chiropractic means a philosophy, science, and healing art concerned
with the restoration and preservation of health and wellness through the promotion of
well-being, prevention of disease, and promotion and support of the inherent or innate
recuperative abilities of the body. The practice of chiropractic includes the reduction of
chiropractic subluxation and the examination, diagnosis, analysis, assessment, systems
of adjustments, manipulation, and treatment of the articulations and soft tissue of the
body. It is within the lawful scope of the practice of chiropractic to diagnose, adjust and
treat the articulations of the spinal column and other joints, articulations, and soft tissue
and to order and administer physical modalities and therapeutic, rehabilitative and
strengthening exercises.
b) During the initial consultation and before commencing chiropractic care, a licensee shall
identify and document a clinical condition warranting chiropractic care. Nothing
contained in this section shall be deemed to prohibit a licensee from caring for
chiropractic subluxation as determined by chiropractic analytical procedures.
Chiropractic analysis that identifies the existence of a subluxation may be the basis for
chiropractic care even in the absence of a subjective complaint or other objective
findings.
c) A chiropractic diagnosis or analysis shall be based upon a chiropractic examination
appropriate to the presenting patient, except that a licensed chiropractor who, at any
time during examinations or treatments, has reasonable cause to believe symptoms or
conditions are present that require diagnosis, analysis, treatment, or methods beyond
the scope of chiropractic as defined in (a) above, shall refer an individual to a
practitioner licensed to practice dentistry, medicine, or surgery in this State or other
appropriate licensed healthcare professionals. Nothing contained in this subsection
shall preclude a licensed chiropractor from rendering concurrent or supportive
chiropractic care to any patient so referred.
d) The following diagnostic and analytical procedures are within the scope of practice of a
licensee:
1)
The taking and ordering of X-rays;
2)
The ordering, but not performing, of bioanalytical laboratory tests consistent with
chiropractic practice;
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3)
The ordering or performing of reagent strip tests (dipstick urinalysis) consistent with
chiropractic practice;
4)
The ordering, but not performing, of such other diagnostic or analytical tests
consistent with chiropractic practice including, but not limited to, computerized axial
tomography (CT), magnetic resonance imaging (MRI), bone scan, and invasive
electromyography (EMG);
5)
The requesting or performing of such other diagnostic or analytical tests consistent
with chiropractic practice including, but not limited to, non-invasive muscle testing
and tests using neurocalometer-type devices;
6)
The requesting or performing of electrodiagnostic tests or other special examinations,
to the extent and in the manner authorized by N.J.A.C. 13:44E-3;
7)
7. The signing or certifying of temporary or permanent impairments and other
certifications, such as pre-employment screenings. A chiropractic physician may use
recognized references in making his or her determination; and
8)
The providing of dietary or nutritional counseling, such as the direction,
administration, dispensing, and sale of nutritional supplements including, but not
limited to, all food concentrates, food extracts, vitamins, minerals, herbs, enzymes,
amino acids, homeopathic remedies, and other dietary supplements including, but not
limited to, tissue or cell salts, glandular extracts, nutraceuticals, botanicals, and other
nutritional supplements; provided that the chiropractor has successfully completed a
course of study concerning human nutrition, consisting of not less than 45 credit
hours from a college or university accredited by a regional or national accrediting
agency recognized by the United States Department of Education and approved by
the Board based upon the criteria set forth in N.J.S.A. 45:9-41.3.
e) When clinically indicated, supported and documented in the patient record, a licensee
may provide the following procedures in conjunction with chiropractic care to facilitate,
enhance and/or prolong the effects of the chiropractic adjustment:
1)
The ordering and/or administering of physical modalities;
2)
The ordering and/or administering of therapeutic, rehabilitative and/or strengthening
exercises; and
3)
Perform splinting and bracing, first aid, and other diagnostic or analytical tests
including computer aided neuromuscular testing and nerve conduction studies.
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f) A chiropractor licensed by the State Board of Chiropractic Examiners may use the title
doctor, or its abbreviation in the practice of chiropractic, however, it must be qualified by
the words doctor of chiropractic, chiropractor or chiropractic physician or its abbreviation
D.C., which may be used interchangeably.
13:44E-1.2 DEFINITIONS
Unless otherwise noted, any reference to “licensee” in Subchapters 1, 1A, 2, and 3 shall mean
solely a chiropractor licensed and subject to regulation by the New Jersey State Board of
Chiropractic Examiners.
SUBCHAPTER 1A.
LICENSURE
13:44E-1A.1 LICENSING REQUIREMENTS FOR A CHIROPRACTOR
a) To be eligible for licensure as a chiropractor in New Jersey, an applicant shall:
1)
Be at least 18 years of age;
2)
Be of good moral character as demonstrated on the application;
3)
Have successfully completed high school or its equivalent;
4)
Have successfully:
i) Completed two years of study in an accredited college or university with at least
one and one-half of the two years of study prior to commencing study in a
chiropractic college or university within a course of study which meets the
requirements set forth in N.J.S.A. 45:9-41.5; and
ii) Graduated from a chiropractic college or university that meets the requirements
set forth in N.J.S.A. 45:9-41.5 during the applicant's entire course of study;
5)
Have passed the National Board of Chiropractic Examiners Examination pursuant to
N.J.A.C. 13:44E-2.13; and
6)
Have passed the New Jersey Chiropractic Jurisprudence Examination.
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13:44E-1A.2 APPLICATION FOR LICENSE: CHIROPRACTOR
a) An applicant for licensure as a chiropractor in New Jersey shall submit the following to
the Board:
1)
A completed application form provided by the Board which shall contain the
applicant's name, address, social security number, academic qualifications, licensure
information from other states, resume, questions demonstrating moral character,
confidential questions concerning the applicant's fitness to practice and child support
questions;
2)
Official transcripts demonstrating completion of the educational requirements
pursuant to N.J.A.C. 13:44E-1A.1(a)4;
3)
Proof of successful completion of the National Board of Chiropractic Examiners
Examination pursuant to N.J.A.C. 13:44E-2.13;
4)
The application fee set forth in N.J.A.C. 13:44E-2.5; and
5)
A certification of authorization to perform and cooperate in a criminal history
background check conducted pursuant to N.J.S.A. 45:1-28 et seq.
13:44E-1A.3 APPLICANTS LICENSED IN OTHER STATES
a) An applicant who is licensed to practice chiropractic by an examining and licensing
board of another state shall be granted a license to practice chiropractic in New Jersey
without further examination provided that:
1)
The examining and licensing board of the applicant's state of licensure has licensure
and examination requirements equivalent to those of this State;
2)
The applicant furnishes an official transcript demonstrating that he or she has
completed the educational requirements set forth in N.J.A.C. 13:44E-1A.1(a)4;
3)
The Board has received evidence of the applicant's good standing in any jurisdiction
where he or she is or has been licensed;
4)
The applicant pays the endorsement license fee as set forth in N.J.A.C. 13:44E-2.5;
and
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5)
The applicant has submitted a certification of authorization to perform and has
cooperated in a criminal history background check pursuant to N.J.S.A. 45:1-28 et
seq.
b) An applicant for a licensure to practice chiropractic in this State who holds a valid
license to practice chiropractic in another state shall be required to successfully
complete the New Jersey Jurisprudence Examination.
c) An applicant who holds a license in good standing to practice chiropractic in another
state, who has five years of postgraduate chiropractic clinical experience and who does
not satisfy the prerequisite educational requirements of N.J.A.C. 13:44E-1A.1(a) 4i,
shall be granted a license to practice chiropractic in New Jersey provided that the
applicant has passed the National Board of Chiropractic Examiners Special Purposes
Examination for Chiropractic.
13:44E-1A.4 BIENNIAL LICENSE RENEWAL; LICENSE EXPIRATION;
REINSTATEMENT AFTER EXPIRATION; INACTIVE STATUS; RETURN FROM
INACTIVE STATUS
a) Licenses to practice chiropractic shall be issued for a period of two years and be
renewed biennially. A licensee who seeks renewal of his or her license shall submit a
license renewal application and the license renewal fee set forth in N.J.A.C. 13:44E-2.5
to the Board prior to the expiration of the current license.
b) If a licensee does not renew his or her license prior to its expiration date, the licensee
may renew the license within 30 days of its expiration by submitting a renewal
application, a license renewal fee and a late fee, as set forth in N.J.A.C. 13:44E-2.5.
c) A license that is not renewed within 30 days of its expiration date shall expire. Any
individual who continues to practice with an expired license after 30 days following the
license expiration date shall be deemed to be engaged in unlicensed practice.
d) An individual whose license has been expired for five years or less for failure to renew
pursuant to (c) above may be reinstated by the Board after fulfilling the following:
1)
Completion of a reinstatement application;
2)
Payment of the reinstatement fee and all past delinquent biennial renewal fees
pursuant to N.J.A.C. 13:44E-2.5;
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3)
Submission of an affidavit of employment listing each job held during the period of
license expiration that includes the name, address and telephone number of each
employer;
4)
Completion of a criminal history background check as required by N.J.S.A. 45:1-28 et
seq., if a criminal history background check has not been completed previously; and
5)
Submission of proof of having completed the continuing education requirements for
each biennial licensure period for which the applicant’s license was expired. If the
total credits required to become current exceeds 30, then 30 shall be the maximum
number required. Any applicant seeking reinstatement of his or her license shall
submit to the Board, a detailed list of all continuing education courses that the
licensee has completed in order to become current. If the Board determines that
there is a deficiency in a particular area of study, the Board may require the applicant
to complete additional continuing education courses in the area of the deficiency
before reinstating the license.
e) An individual whose license has been expired for more than five years, and has been
lawfully practicing in another jurisdiction, shall complete the requirements set forth in
(d)1 through 5 above.
f) An individual whose license has been expired for more than five years, and has not
been lawfully practicing in another jurisdiction, shall:
1)
Complete the requirements set forth in (d)1 through 5 above; and
2)
Successfully complete the Special Purposes Examination for Chiropractic
administered by the National Board of Chiropractic Examiners.
g) Renewal applications shall provide the licensee with the option of either active or
inactive status. A licensee electing inactive status shall pay the applicable inactive fee
set forth in N.J.A.C. 13:44E-2.5 and shall not engage in practice.
h) A licensee who elected inactive status and has been on inactive status for five years or
less may be reinstated by the Board after fulfilling the following:
1)
Payment of both the reinstatement and current fees as set forth in N.J.A.C. 13:44E-
2.5;
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2)
Submission of an affidavit of employment listing each job held during the period the
licensee was on inactive status including the name, address and telephone number
of each employer;
3)
Completion of a criminal history background check as required by N.J.S.A. 45:1-28 et
seq., if a criminal history background check has not been completed previously; and
4)
Submission of proof of completion of the continuing education credits required
pursuant to N.J.A.C. 13:44E-1A.5.
i) A licensee who has been inactive for five or more years, and has been lawfully practicing
in another jurisdiction, shall complete the requirements set forth in (h)1 through 3 above.
j) A licensee who has been inactive for five years or more, and has not been lawfully
practicing in another jurisdiction, shall:
1)
Complete the requirements set forth in (h)1 through 3 above; and
2)
Successfully complete the Special Purposes Examination for Chiropractic
administered by the National Board of Chiropractic Examiners.
k) Falsification of any information submitted with the renewal application may result in
penalties and/or suspension of the license pursuant to N.J.S.A. 45:1-21 through 25.
13:44E-1A.5 Chiropractic continuing education
a) “Licensee,” as used in this section, means a chiropractor licensed and subject to
regulation by the Board of Chiropractic Examiners.
b) A licensee applying for biennial license renewal shall have completed, during the
preceding biennial period, 30 continuing educational credits in order to qualify for the
renewal of his or her license. One credit is defined as 50 minutes of instruction. A
minimum of two credits shall be completed in the study of State laws and rules governing
chiropractic professional ethics or recordkeeping and documentation as it pertains to the
practice of chiropractic in this State, and a minimum of two credits shall be completed in
nutrition education.
c) The continuing education courses may include, but not be limited to, subject matter and
content of study that is taught by accredited chiropractic schools, colleges, institutions,
and universities, or in a subject matter tested for licensure, that has been approved by
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Providers of Approved Continuing Education (PACE), and/or the Board; except that the
Board retains the right to reject any PACE-approved program:
1. Whose focus is the subject matter described in (i) below; or
2. That does not have significant intellectual or practical content dealing primarily with
matters directly related to the practice of chiropractic or with professional responsibilities
or ethical obligations of licensees.
d) The Board will not grant continuing education credit for completion of basic courses
required for graduation from a chiropractic college or university and/or for initial
licensure. Continuing education credit shall be granted only for post-doctoral courses
designed to build upon basic knowledge and/or to bring licensees up-to-date on new
developments relating to the practice of chiropractic.
e) The Board may accredit other educational programs offered by professional organizations
or societies, health care professions, schools, colleges, institutions, universities or
healthcare facilities as suitable for continuing education credits, so long as such other
educational programs have significant intellectual or practical content, which deal
primarily with matters directly related to the practice of chiropractic or with the
professional responsibilities or ethical obligations of licensees and whose focus is not the
subject matter described in (i) below.
f) The Board may accredit other equivalent educational programs including, but not limited
to, examinations, scientific papers, professional publications, scientific presentations,
residency programs, teaching and/or research appointments, advanced degree or
certification program in related fields, scientific exhibits, independent study or research,
or self-study programs, or distance learning as suitable for continuing education credits,
so long as such other educational programs have significant intellectual or practical
content, which deal primarily with matters directly related to the practice of chiropractic or
with the professional responsibilities or ethical obligations of licensees and whose focus
is not the subject matter described in (i) below.
g) Continuing education credit shall be calculated as follows:
1. Continuing professional education programs of national or State professional
organizations: one credit hour for every 50 minutes of in-class participation;
2. Accredited university or college courses in the subjects set forth in (d) above:
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i. Applicants shall receive 15 credit hours of continuing education credit for each
semester or trimester credit hour earned; 10 credit hours of continuing education
credit for each credit hour earned in a quarter; and
ii. Applicants attending noncredit courses shall be granted continuing education
credit at the rate of one credit hour for every 50 minutes of in-class participation;
3. Distance learning programs and other independent study programs: the amount of
credit to be allowed for approved distance and individual study programs, including taped
study programs, shall be one credit hour for every 50 minutes of distance and individual
self-study program participation;
4. Teaching or instruction of a course for the first time or teaching a course previously
taught if substantial time was spent updating course material: instruction and preparation
time: one continuing education credit for each hour of instruction or preparation.
i. The total number of continuing education credits that may be granted for
service as a teacher or instructor shall not exceed 12 credits per biennial period.
ii. Requests for credit shall be accompanied by an outline of the instruction or
course.
iii. A teacher or instructor that is employed as a teacher or instructor on a full-time
basis shall not be eligible to obtain continuing education credits for such
activities;
5. Scientific papers and professional publications: credit shall be given for each 50-
minute period of preparation time on a self-declaration basis, not to exceed 12 credit-
hours per biennial period. A copy of the publication article shall be submitted to the
Board with a request for continuing education credit.
i. Credit may be claimed for published articles and books by the authors of those
works. These publications must contribute to the professional competency of
chiropractors.
ii. In exceptional circumstances, a licensee may request additional credit by
submitting the article or book to the Board with an explanation of the
circumstances that he or she believes justifies an award of greater credit. When
licensees request more than 12 continuing education credit hours during the
biennial period, credit hours awarded shall be determined by the Board on a
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case-by-case basis. Factors such as complexity of the subject matter, length of
publication, and the amount of preparation time shall be considered;
6. Research and preparation of examinations or acting as an examiner for a clinical
examination: one continuing education credit for each hour of research or time spent on
the examination, not to exceed six continuing education credits per biennial period; and
7. Scientific presentations or exhibits: one continuing education credit for each hour of
preparation or presentation, not to exceed six continuing education credits per biennial
period.
h) A licensee shall complete no more than 12 of the total continuing chiropractic education
credits by asynchronous distance learning courses where the instructor and the learner are
not in direct, live communication during the course, approved by the Board; the remaining
credits must be attained through live didactic learning experience, including synchronous
distance learning activities where the instructor and learner are in direct live communication
during the course. The Board shall not award more than 10 hours of continuing education
credit for any program that takes place during the course of one calendar day.
i) The Board shall not accept courses involving practice building, practice management
and/or practice marketing toward the continuing chiropractic education requirements.
j) A provider seeking Board approval to sponsor programs for continuing education credit
shall submit an application to the Board, which shall include course and program
descriptions, instructor qualifications, locations, dates and times of courses, and other
information as required by the Board.
1. Qualified sponsors shall offer courses that meet the following criteria:
i. Be a formal course of learning, which contributes directly to the maintenance of
professional competence of a licensee;
ii. Be at least one credit hour, 50-minute period, in length; however additional
credits in excess of one hour may be awarded in ½ hour increments;
iii. Be conducted by a qualified instructor or discussion leader; and
iv. Offer subjects enumerated in (c) above.
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2. A continuing education sponsor may receive prior approval, valid for the current
biennial licensing period in which the approval was issued, for a course of acceptable
subject matter, as set forth in (c) above, and be assigned a designated number of
continuing education credits by the Board if the program sponsor provides in writing
information required by the Board to document the elements of (j)1 above, and in
addition, certifies that the sponsor shall:
i. Maintain and retain accurate records of attendance for a five-year period;
ii. Retain a written outline of course materials for a five-year period; and
iii. Comply with the requirements of (j)4 below.
3. The Board will post on its website at
http://www.njconsumeraffairs.gov/chiro/chiro_licensee.htm a list of all program sponsors
that, pursuant to this section, have applied and have been approved to sponsor courses
for continuing education credit. Continuing education sponsors shall comply with the
following additional requirements:
i. The program sponsor shall disclose in advance to prospective participants the
objective, prerequisites, experience level, content, required advanced
preparation, teaching method, and number of continuing education credits
involved in the program;
ii. The program sponsor shall provide evidence to the Board that it has policies
and procedures in place to verify and adequately monitor the attendance of
course participants;
iii. The program sponsor shall be responsible for assuring that the number of
participants and the physical facilities are consistent with the teaching methods to
be utilized;
iv. The program sponsor shall select and assign qualified instructors for the
continuing education program. Sponsors shall provide to the Board the curriculum
vitae of all course instructors and certify to the Board that the sponsor has
verified the credentials of all its instructors. Sponsors must notify the Board of
any instructor change within 20 days of making the change;
v. The program sponsor shall evaluate the performance of its program instructors
at the conclusion of each program to determine the instructors’ suitability to
continue to serve as instructors in the future;
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vi. Program evaluation shall be in accordance with the following:
1) The sponsor shall provide some means of program evaluation.
Evaluations shall be solicited from both the participants and instructors.
Programs shall be evaluated to determine whether:
A) Objectives were met;
B) Prerequisites were necessary or desirable;
C) Facilities were satisfactory;
D) The instructor was effective;
E) Advanced preparation materials were satisfactory; and
F) The program content was timely and effective; and
2) Evaluations shall take the form of one or a combination of pre-tests for
advanced preparation, post-tests for effectiveness of the program,
questionnaires completed at the end of the program or later, or oral
feedback to the instructor or sponsor. Instructors shall be informed of their
performance and sponsors shall systematically review the evaluation
process to insure its effectiveness; and
vii. The program sponsor shall be responsible for issuing certificates of
satisfactory completion or other comparable documentation to program
participants. Such certificates or documentation shall be printed with the following
information:
1) Dates attended;
2) Credit hours earned;
3) Course title and description of content, including the method of course
delivery and subject area;
4) Course sponsor name;
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5) Instructor name; and
6) Course location.
4. A continuing education sponsor who has qualified as a sponsor pursuant to (j)1 above,
or has obtained prior Board approval for a course pursuant to (j)2 above, shall not alter,
amend, update, or reconfigure the approved courses for continuing education credit
without the permission of the Board. If a continuing education sponsor alters, amends,
updates, or reconfigures a course, the continuing education sponsor must resubmit the
course to the Board for approval.
k) A licensee seeking Board approval of a program for continuing education credit, which has
not been approved pursuant to (j) above, may submit an application on a form prescribed by
the Board, which shall include course and program descriptions, instructor qualifications,
locations, dates and times of courses, number of continuing education credits, and other
information as required by the Board. The Board shall notify the licensee, in writing, of its
determination, which is based upon (d), (e), and (f) above.
l) All coursework required for certification to perform specialized examinations or
electrodiagnostic tests referred to in N.J.A.C. 13:44E-3.5(a)2 must be preapproved by the
Board at least 90 days prior to the date the course begins.
1. A program provider seeking preapproval of a course shall follow the approval process
set forth at (j) above.
2. A licensee seeking preapproval of a course shall follow the approval process set forth
at (k) above.
m) A new licensee who completed an accredited graduate chiropractic education program
within 12 months of the commencement of the biennial registration period is not required to
complete the continuing education requirements for the biennial period.
n) A licensee shall certify on the application for biennial licensure renewal that he or she has
completed the required number of continuing education credits. The Board may conduct
random audits to determine licensee compliance with the continuing education requirements
of this section.
o) A licensee who completes more than 30 continuing chiropractic education credits
required pursuant to this section may apply no more than seven of the excess credits to the
continuing chiropractic education requirements for the following biennial period only. Excess
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credits approved for a biennial period may be applied to the continuing education
requirements for the next period whether or not approved for that period.
p) Licensees holding an inactive or retired license shall be exempt from continuing
education requirements, except that any licensee holding an inactive or retired license, or
whose license is suspended or revoked, who applies to resume practice shall provide proof
of having completed the continuing chiropractic education requirements for each biennial
licensure period for which the licensee was on inactive or retired status. If the total credits
required to become current exceeds 30, then 30 shall be the maximum number required. Any
applicant seeking to resume practice shall submit to the Board a detailed list of all continuing
education courses that the licensee has completed in order to become current. If the Board
determines that there is a deficiency in a particular area of study, the Board may require the
applicant to complete additional continuing education courses in the area of the deficiency
before reinstating the license to active status.
q) To report continuing chiropractic education credits, a licensee shall:
1. Certify, on the application for biennial renewal, completion of the required number of
continuing education credits; and
2. Maintain all evidence of completion of continuing education requirements for a period
of not less than five years after satisfaction of the credits and submit such documentation
to the Board upon request.
r) The board may extend the time period for completion of continuing chiropractic education
requirements or may waive continuing chiropractic education requirements on an individual
basis for reasons of hardship, such as severe illness, disability or military service, consistent
with the following:
1. A licensee seeking an extension or waiver of the continuing education requirements
shall apply to the Board in writing setting forth the specific details for the reasons why an
extension or a waiver is requested. The licensee shall submit all of the documentation
that supports the request for the extension and/or waiver;
2. A licensee shall apply for an extension and/or a waiver prior to the expiration of the
biennial renewal period. All requests shall be sent to the Board office, by certified mail,
return receipt requested; and
3. An extension or waiver granted pursuant to this section shall become effective for the
biennial licensure period in which the extension or waiver is granted. If the condition that
necessitated the extension or waiver continues into the next biennial period, the licensee
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shall apply to the Board for the renewal of such extension or waiver for the new biennial
period.
s) A licensee shall provide verification and proof of compliance with continuing chiropractic
education requirements. Non-compliance with the continuing education requirements shall
provide cause for civil penalties pursuant to N.J.S.A. 45:9-41.32.
t) A second or subsequent offense by a licensee for failure to comply with the continuing
education requirements may be considered professional misconduct and would provide
grounds for additional discipline including license suspension or revocation.
13:44E-1A.6 Malpractice insurance
a) The following words and terms, when used in this section, shall have the following
meanings, unless the context clearly indicates otherwise:
“Authorized” means recognized by a government agency to offer chiropractic malpractice
insurance products.
“Covered” means ongoing maintenance of insurance in the amount of at least $100,000
per occurrence and $300,000 per policy year with extended reporting endorsement
coverage for claims made (or “tail coverage”) issued by a carrier or other entity
authorized to write chiropractic malpractice insurance.
“Maintaining a professional practice with responsibility for patient care” means the
furnishing of professional services to patients in New Jersey including, but not limited to,
the testing for, or diagnosis of, or the offering or furnishing of treatment, preventative
chiropractic care or consultation relating to chiropractic care at a place, such as an office
(even if located in the home) or clinic or through a business entity, regardless of the
ownership of the practice.
b) All doctors of chiropractic licensed to practice in this State who maintain a professional
practice or have responsibility for patient care shall be covered by chiropractic malpractice
insurance.
c) All New Jersey-licensed chiropractic assistants working for a doctor of chiropractic as
described in (b) above shall be covered by the malpractice insurance policy of that practice.
d) Violations of (b) and (c) above shall be deemed professional misconduct within the
meaning of N.J.S.A. 45:1-21(e).
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SUBCHAPTER 2.
GENERAL RULES OF PRACTICE
13:44E-2.1 ADVERTISING
a) The following words and terms, when used in this section, shall have the following
meanings unless the context clearly indicates otherwise.
1)
"Advertisement" means the attempt, directly or indirectly by publication,
dissemination, solicitation, endorsement or circulation in print or electronic media or
in any other way, to attract directly or indirectly any person to enter into an expressed
or implied agreement to accept chiropractic services or care or goods related thereto.
2)
"Electronic media" means, but is not limited to, radio, television, telephone, facsimile
machine, and computer.
3)
"Print media" means newspapers, magazines, periodicals, professional journals,
telephone directories, circulars, handbills, fliers or other publications, the content of
which is disseminated by means of the printed word.
4)
"Range of fees" means an expressly stated upper and lower limit on the fee charged
for a professional service.
5)
"Routine professional service" means a service which the advertising licensee,
professional association or institution providing chiropractic care routinely performs.
b) A licensed chiropractor who is actively engaged in the practice of chiropractic in the
State of New Jersey may provide information to the public by advertising in print or
electronic media. Advertisements may include references to licensed chiropractic
assistants employed with a licensed chiropractor, provided the title “licensed
chiropractic assistant” or the abbreviations “L.C.A.” is included in the advertisement.
c) A licensee who engages in the use of advertising that contains the following shall be
deemed to be engaged in professional misconduct:
1)
Any statement, claim, or format which is false, fraudulent, misleading or deceptive;
2)
Claims that the professional service performed or the materials used are superior to
that which is ordinarily performed or used unless such claims can be substantiated by
the licensee;
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3)
Promotion of a professional service that the licensee knows or should know is
beyond the licensee's ability to perform or beyond the ability of other staff to perform;
4)
Techniques of communication which appear to intimidate, exert undue pressure or
undue influence over a prospective patient;
5)
The communication of personally identifiable facts, data, or information about a
patient without the patient's signed written permission obtained in advance;
6)
The use of any misrepresentation;
7)
The suppression, omission or concealment of any material fact under circumstances
which a Board licensee knows or should know that the omission is improper or
prohibits a prospective patient from making a full and informed judgment on the basis
of the information set forth in the advertisement;
8)
Any print, language or format which directly or indirectly obscures a material fact;
9)
Any guarantee that services rendered will result in a cure; or
10)
Any violations of (d) through (l) below.
d) The Board may require a licensee to provide factual substantiation of the truthfulness of
any objective assertion or representation set forth in an advertisement.
e) A Board licensee shall not engage directly or indirectly in uninvited, in-person
solicitation of actual or potential patients who, because of their particular circumstances,
are vulnerable to undue influence. This subsection shall not prohibit the offering of
services by a Board licensee to any bona fide representative of prospective patients
including, but not limited to, employers, labor union representatives, or insurance
carriers.
f) Advertising making reference to or setting forth a fee shall be limited to that which
contains a fixed or a stated range of fees for a specifically described professional
service or class of services. A licensee who advertises shall disclose all the relevant
variables and considerations which are ordinarily included in such a service so that the
fees will not be misunderstood. In the absence of such a disclosure, the stated fees
shall be presumed to include everything ordinarily required for such a service. No
additional charges shall be made for an advertised service unless the advertisement
includes the following disclaimer:
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"Additional charges may be incurred for related services which may be required in
individual cases."
1)
The disclaimer as set forth above shall not be used for treatment where related
services are ordinarily required.
2)
In any advertisement in which examination fees are set forth, the cost of x-rays shall
also be set forth along with the disclosure: "if needed."
g) Offers of discounts or fee reductions or free services shall indicate the advertiser's fixed
or stated range of fees against which said discount is to be made and/or the value of the
free services. Chiropractic services that are routinely or ordinarily performed free of
charge, shall be clearly and conspicuously stated in the body of the advertisement as
such.
1)
The fixed or stated range of fees or value of free services shall mean and be
established on the basis of the advertiser's most commonly charged fee for the stated
service within the most recent 60 days prior to, or to be charged in the first 60 days
following, the effective date of the advertisement.
2)
Offers of across-the-board discounts shall include a representative list of services
and the fixed or stated range of fees against which discounts are to be made for
these services. The list shall include a sampling of the advertiser's most frequently
performed services.
i) "Across-the-board discounts" shall mean the offer of a specified discount on an
undefined class of services or the offer of a specified discount to a defined class of
patients. For example, "15% discount during April on all chiropractic services" or
"15% discount to senior citizens on all chiropractic services."
ii) Example of Representative List of Services:
Regular Fee Discount Fee
Consultation $_________ $__________
Examination _________ __________
Complete X-rays _________ __________
Physical Modality _________ __________
iii) The effective period during which a fee or discount shall remain in effect shall be
set forth on the face of the advertisement. In the absence of such disclosure, the
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effective period shall be deemed to be 30 days from the date of the
advertisement's initial publication.
3)
Except as set forth in (g)4 below, a licensee shall not charge any patient responding
to an advertisement offering free or reduced fee services for any service rendered
during a period of 24 hours from the time the advertised free or reduced fee service
was rendered.
4)
In the event a patient responding to an advertisement offering free or reduced fee
services is in need of services other than those advertised as free or reduced,
including extraordinary diagnostic services or immediate chiropractic care, the
licensee shall not charge for any such services rendered during a period of 24 hours
from the time the advertised free service was rendered unless the practitioner obtains
a signed waiver from the patient. The waiver shall be in the following form:
WAIVER
I have responded to an advertisement for a free examination or initial
consultation with Dr. DC. Dr. has explained
to me that, pursuant to the regulations of the New Jersey Board of Chiropractic
Examiners, he or she cannot charge for any service rendered during a period of
24 hours from the time he or she gives me the free examination or consultation
examination unless there is an immediate need for service and I sign this waiver.
I have what I believe is a need for immediate chiropractic care. Therefore, I
agree to sign this waiver and pay for the immediate chiropractic care rendered
within the 24-hour period. The amount Dr. will charge me for
chiropractic care is $_________.00. This figure was written on the line before I
signed this waiver.
I have been given a copy of this waiver by Dr. or someone
from his or her office. If I have any concerns, I can write to the New Jersey State
Board of Chiropractic Examiners at PO Box 45004, Newark, NJ 07101.
Patient’s signature_______________________
Patient’s name printed____________________
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Date__________________________________
h) An advertisement may contain either a lay or expert testimonial, provided that such
testimonial is based upon personal knowledge or experience obtained from a provider
relationship with the licensee or direct personal knowledge of the subject matter of the
testimonial. A lay person's testimonial shall not attest to any technical matter beyond the
testimonial giver's competence to comment upon. An expert testimonial shall be
rendered only by an individual possessing specialized expertise sufficient to allow the
rendering of a bona fide statement or opinion. An advertiser shall be able to
substantiate any objective, verifiable statement of fact appearing in the testimonial.
i) All licensee advertisements and public representations shall contain the name and
address or telephone number of the licensee, professional service corporation or trade
name under which the practice is conducted and shall also set forth the name of at least
one licensee responsible for the chiropractic practice in the facility identified in the
advertisement and/or public representation.
j) A licensee shall be presumed to have approved and shall be personally responsible for
the form and contents of an advertisement which contains the licensee's name, office
address, or telephone number. A licensee who employs or allows another to employ for
his or her benefit an intermediary source or other agent in the course of advertising shall
be personally responsible for the form and contents of said advertisement.
k) A video or audio tape of every advertisement communicated by electronic media shall
be retained by the licensee and made available for review upon request by the board or
its designee.
l) A licensee shall retain a copy of all advertisements for a period of three years. All
advertisements in the licensee's possession shall indicate the accurate date and place
of publication and/or dissemination.
13:44E-2.2 PATIENT RECORDS
a) A contemporaneous, permanent patient record shall be prepared and maintained by a
licensee, which may include information collected by licensed chiropractic assistants, for
each person seeking chiropractic services, regardless of whether any care is actually
rendered or whether any fee is charged. Licensees also shall maintain records relating
to billings made to patients and third party carriers for professional services. All patient
records, bills and claim forms shall accurately reflect the care or services rendered.
Such records shall include, as a minimum:
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1)
The name, address, and date of birth of the patient and, if a minor, the name of the
parent or guardian;
2)
The patient complaint/reason for visit;
3)
A pertinent case history;
4)
Findings on appropriate examination;
5)
Diagnosis/analysis;
6)
A care plan;
7)
Any orders for tests or consultations including the clinical indications and the results
thereof;
8)
The dates of each patient visit;
9)
A description of care or services rendered at each visit together with the name of the
licensee or other person rendering the care;
10)
Notation of significant changes in patient's condition and/or significant changes in
care plan;
11)
Periodic notation of patient status regardless of whether significant changes have
occurred; and
12)
An itemized statement of the amount billed and received on patient's account.
b) Patient records, including all radiographs and other diagnostic findings, shall be
maintained for at least seven years from the date of the last entry. In the case of a minor
child, records shall be kept for seven years from the date of the last entry or seven
years from the date of majority, whichever is later.
c) All radiographs shall be labeled, as a minimum, with the following identifying
information:
1)
The name of patient;
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2)
The date of radiograph;
3)
The age of patient and/or date of birth;
4)
The name of facility; and
5)
Right or left identity.
d) Licensees shall provide access to patient records to the patient or the patient's
authorized representative in accordance with the following:
1)
Upon receipt of a written request from a patient or an authorized representative and
within 30 days thereof, legible copies of the patient record including, if requested,
copies of radiographs, shall be furnished to the patient or an authorized
representative or another designated health care provider. To the extent that the
record is illegible or prepared in a language other than English, the licensee shall
provide a typed transcription and/or translation at no cost to the patient.
2)
Except where the complete record is required by applicable law, the licensee may
elect to provide a summary of the record, as long as that summary accurately reflects
the patient's history and care, where the written request comes from an insurance
carrier or its agent with whom the patient has a contract which provides that the
carrier be given access to records to assess a claim for monetary benefits or
reimbursement.
3. A licensee shall provide copies of records in a timely manner to a patient or
another designated health care provider where the patient's continued care is
contingent upon their receipt. The licensee shall not refuse to provide a patient
record on the grounds that the patient owes the licensee an unpaid balance if the
record is needed by another health care professional for the purpose of rendering
care.
4. A licensee may refuse to release a record to a patient if, in the exercise of
professional judgment, a licensee has reason to believe that the patient may be
harmed by release of the subjective information contained in the patient record or a
summary thereof. The record or the summary, with an accompanying notice setting
forth the reasons for the original refusal, shall nevertheless be provided upon request
of and directly to:
i) The patient's attorney;
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ii) Another licensed health care professional; or
iii) The patient's health insurance carrier.
5) The licensee may charge a reasonable fee for the reproduction of records, which
shall be no greater than an amount reasonably calculated to recoup the cost of
copying or transcription.
e) Licensees shall maintain the confidentiality of patient records, except that:
1)
Upon receipt of a written request from a patient or an authorized representative and
within 30 days thereof, legible copies of the patient record including, if requested,
copies of radiographs, shall be furnished to the patient or an authorized
representative or another designated health care provider. To the extent that the
record is illegible or prepared in a language other than English, the licensee shall
provide a typed transcription and/or translation at no cost to the patient.
2)
The licensee, in the exercise of professional judgment and in the best interests of the
patient (even absent the patient's request), may release pertinent information about
the patient's care to another licensed health care professional who is providing or
who has been asked to provide care to the patient, or whose expertise may assist the
licensee in his or her rendition of professional services.
3)
A licensee shall provide copies of records in a timely manner to a patient or another
designated health care provider where the patient's continued care is contingent
upon their receipt. The licensee shall not refuse to provide a patient record on the
grounds that the patient owes the licensee an unpaid balance if the record is needed
by another health care professional for the purpose of rendering care.
f) Where a third party or entity has requested examination or an evaluation of a person for
a purpose unrelated to care by the examiner and where a report of the examination is to
be supplied to the third party, the licensee rendering those services shall prepare
appropriate records and maintain their confidentiality, except to the extent provided by
this section. The licensee's report to the third party relating to the patient shall be made
part of the record. The licensee shall:
1)
Assure that the scope of the report is consistent with the request, to avoid the
unnecessary disclosure of diagnoses or personal information which is not pertinent;
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2)
Forward the report to the individual entity making the request and in accordance with
the terms of the patient's authorization; if no specific individual is identified, the report
should be marked "Confidential"; and
3)
Should the examination disclose abnormalities or conditions not known to the patient,
the licensee shall advise the patient to consult another health care professional for
treatment.
g) If a licensee ceases to engage in practice or it is anticipated that he or she will remain
out of practice for more than three months, the licensee or a designee shall:
1)
Establish a procedure by which patients can obtain patient records or acquiesce in
the transfer of those records to another licensee or health care professional who is
assuming the responsibilities of that practice;
2)
If the practice is unattended by another licensee, publish a notice of the cessation
and the established procedure for the retrieval of records in a newspaper of general
circulation in the geographic location of the licensee's practice, at least once each
month for the first three months after the cessation;
3)
File a notice of the established procedure for the retrieval of records with the Board
of Chiropractic Examiners; and
4)
Make reasonable efforts to directly notify any patient treated during the six months
preceding the cessation in order to provide information concerning the established
procedure for the retrieval of records.
13:44E-2.3 SEXUAL MISCONDUCT
a) By this section, the State Board of Chiropractic Examiners is identifying for its licensees
conduct that it shall deem to be violative of law.
b) As used in this section, the following terms have the following meanings unless the
context indicates otherwise:
1)
"Licensee" means any person licensed to engage in the practice of chiropractic as
regulated by the State Board of Chiropractic Examiners.
2)
"Patient" means any person who is the recipient of a professional service rendered
by a licensee for the purposes of diagnosis, care or a consultation relating to
chiropractic care. "Patient" for purposes of this section also means a person who is
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the subject of professional examination even if the purpose of that examination is
unrelated to care.
3)
"Patient-chiropractor relationship" means an association between a chiropractor and
patient wherein the licensee owes a continuing duty to the patient to be available to
render professional services consistent with his or her chiropractic training and
experience. The performance of any professional chiropractic service includes, but is
not limited to, any consultation, examination, and care provided by a licensee in
furtherance of chiropractic care or consultation.
4)
"Sexual contact" means the knowing touching of a person's body directly or through
clothing, where the circumstances surrounding the touching would be construed by a
reasonable person to be motivated by the licensee's own prurient interest or for
sexual arousal or gratification. "Sexual contact" includes, but is not limited to, the
imposition of a part of the licensee's body upon a part of the patient's body, sexual
penetration, or the insertion or imposition of any object or any part of a licensee or
patient's body into or near the genital, anal or other opening of the other person's
body. "Sexual contact" does not include the touching of a patient's body which is
necessary during the performance of a generally accepted and recognized
chiropractic technique.
5)
"Sexual harassment" means solicitation of any sexual act, physical advances, or
verbal or nonverbal conduct that is sexual in nature, and which occurs in connection
with a licensee's activities or role as a provider of chiropractic services, and that
either: is unwelcome, offensive to a reasonable person, or creates a hostile
workplace environment, and the licensee knows, should know, or is told this; or is
sufficiently severe or intense to be abusive to a reasonable person in that context.
"Sexual harassment" may consist of a single extreme or severe act or of multiple acts
and may include, but is not limited to, conduct of a licensee with a patient, co-worker,
employee, student or supervisee whether or not such individual is in a subordinate
position to the licensee.
"Spouse" means the husband, wife or fiancée of the licensee or an individual
involved in a long-term committed relationship with the licensee.
i) For purposes of this section, a long-term committed relationship means a
relationship which is at least six months in duration.
c) A licensee shall not engage in sexual contact with a patient with whom he or she has a
patient-chiropractor relationship. The patient-chiropractor relationship is considered
ongoing for purposes of this section, unless:
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1)
Professional services are terminated by written notice to the patient via certified mail
return receipt requested and documentation in the patient record; and
2)
Three months have elapsed since the last professional service was rendered.
d) A licensee shall not seek or solicit sexual contact with a patient with whom he or she
has a patient-chiropractor relationship and shall not seek or solicit sexual contact with
any person in exchange for professional services.
e) A licensee shall not engage in any discussion of an intimate sexual nature with a
patient, unless that discussion is related to legitimate patient needs. Such discussion
shall not include disclosure by the licensee of his or her own intimate sexual
relationships.
f) A licensee shall provide privacy and examination conditions which prevent the exposure
of the unclothed body of the patient unless necessary to the professional chiropractic
services being rendered.
g) A licensee shall not engage in sexual harassment in a professional setting while
performing in a professional capacity.
h) A licensee shall not engage in any other activity which would lead a reasonable person
to believe that the activity serves the licensee's personal prurient interests or is for the
sexual arousal, or sexual gratification of the licensee or patient or which constitutes an
act of sexual abuse.
i) Violation of any of the prohibitions or directives set forth at (c) through (h) above shall
be deemed to constitute professional misconduct pursuant to N.J.S.A. 45:1-21(e).
j) Nothing in this section shall be construed to prevent a licensee from rendering any
professional chiropractic service to a spouse, providing that the rendering of such
service is consistent with accepted standards of chiropractic care and that the
performance of chiropractic services is not utilized to exploit the patient spouse for the
sexual arousal or sexual gratification of the licensee.
k) It shall not be a defense to any action under this section that:
1)
The patient solicited or consented to sexual contact with the licensee; or
2)
The licensee was in love with or had affection for the patient.
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13:44E-2.4 CHIROPRACTOR OF RECORD; FEE REIMBURSEMENT
a) Each patient in a chiropractic facility shall have a chiropractor of record who shall
remain primarily responsible for assuring the proper implementation of the chiropractic
services to be rendered to such patient regardless of whether the services are rendered
by the chiropractor of record or by any other person rendering chiropractic services or
ancillary care to the patient.
b) The name of the chiropractor of record shall be conspicuously identified on the patient
record. If the chiropractor of record is not identified on the patient record, it shall be
presumed that the chiropractor of record is the owner of the practice in which the patient
received care.
c) Each chiropractor or any other person rendering services shall sign or initial each entry
on the patient record pertaining to the services he or she provided. If no such entry
appears on the patient record, it shall be presumed that such service was rendered by
the chiropractor of record, unless the chiropractor of record establishes the identity of
the individual who provided such services.
d) In a multi-chiropractor practice, the chiropractor of record shall remain the chiropractor
for a patient until a subsequent chiropractor affirmatively notes in the patient record that
he or she is currently the chiropractor of record. In the event that the chiropractor of
record leaves the practice, a successor chiropractor shall be designated if the patient
elects to continue treatment in the facility.
e) A new chiropractor of record shall review the patient's history and chiropractic records,
examine the patient, if necessary, and either develop a new treatment plan or continue
the pre-existing plan.
f) Any chiropractor found to have rendered services in violation of N.J.S.A. 45:1-21 and
the owner of the facility in which the licensee render such services shall be jointly and
severally responsible for any restoration of patient fees as may be ordered by the
Board.
13:44E-2.5 FEE SCHEDULE
a) The following fees shall be charged by the Board:
1)
Application Fee .................................................................................. $125.00
2)
Endorsement Fee .............................................. 75.00 (plus initial license fee)
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3)
Initial License Fee: ...........................................................................................
i) During the first year of a biennial renewal period ............................ 350.00
ii) During the second year of a biennial renewal period ...................... 175.00
4)
Biennial License Renewal Fee ............................................................. 350.00
5)
Duplicate License Fee ............................................................................ 25.00
6)
Verification of Licensure Fee .................................................................. 40.00
7)
Late Renewal Fee .................................................................................. 50.00
8)
Reinstatement Fee ............................... 125.00 (plus all past due license fees)
9)
Electrodiagnostic Testing and Special Examination Certification Fee ..... 50.00
10)
Inactive license fee ......................... (to be determined by the Director by rule)
13:44E-2.6 REFERRAL FEES
It shall be professional misconduct for a licensee to pay, offer to pay, or to receive from any
person any fee or other form of compensation for the referral of a patient. This section shall not
prohibit the division of fees among licensees engaged in a bona fide employment, partnership or
corporate relationship for the delivery of professional services.
13:44E-2.6A PATIENT RECORD REVIEW
a) As used in this section, the term, "patient record review" means an evaluation of all
records which are maintained pursuant to N.J.A.C. 13:44E-2.2 and which are relevant to
the treatment or condition under evaluation by a non-attending chiropractor with regard
to the effectiveness and application of prior treatment or termination of or continuation
of the treatment.
b) A non-attending chiropractor who performs a patient record review, which evaluates
prior chiropractic care or the need for continued chiropractic care or the necessity for
diagnostic testing, shall make a reasonable and documented effort to obtain all records
of the attending chiropractor relevant to the chiropractic care or condition under
evaluation before rendering an opinion concerning the prior chiropractic care, the need
for continued chiropractic care or the need for diagnostic testing.
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c) An opinion by a non-attending chiropractor which states that prior chiropractic care was
not documented pursuant to N.J.A.C. 13:44E-2.2 shall clearly note the specific
deviations from the patient record requirements of N.J.A.C. 13:44E-2.2.
d) Opinions which state that prior chiropractic care was not necessary, not required or
palliative shall clearly state the rationale upon which the opinion is based.
e) (Reserved)
f) An opinion by a non-attending chiropractor that diagnostic testing, referrals or
consultations were not properly documented or performed in accordance with N.J.A.C.
13:44E-2.2 and 13:44E-3 shall clearly note the specific deviations from those rules.
g) Opinions which state that prior diagnostic testing, referrals or consultations were not
necessary shall clearly state the rationale upon which the opinion is based.
h) Any opinion rendered regarding the evaluation of prior chiropractic care, the termination
of chiropractic care, or the necessity of diagnostic testing and/or referrals or
consultation shall be consistent with N.J.S.A. 45:9-14.5 and N.J.A.C. 13:44E-1.1.
Violations of any of the provisions set forth in this section shall constitute professional
misconduct pursuant to N.J.S.A. 45:1-21(e) and may subject licensees to penalties as
set forth in N.J.S.A. 45:1-22 and 45:1-25.
13:44E-2.7 DELEGABLE TASKS OR FUNCTIONS OF CHIROPRACTIC AIDES
LICENSED CHIROPRACTIC ASSISTANTS
a) The following words and terms, when used in this section, shall have the following
meanings unless the context clearly indicates otherwise:
1)
"Chiropractic aide" means any person who does not hold a valid New Jersey
chiropractic or chiropractic assistant license, or a license, certification or registration
issued pursuant to law that authorizes the performance of acts that, absent such
authorization, would be unlawful.
2)
“Licensed chiropractic assistant” means a person who is licensed pursuant to the
provisions of section 5 through 8 of P.L. 2015, c. 283 and the rules set forth in this
subchapter and in N.J.A.D. 13:44E-4 to practice chiropractic assistance under the
supervision of a licensed chiropractor.
3)
“Plan of care” means a documented treatment plan designed by a licensed
chiropractor for the treatment of a patient.
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4)
“Supervision” means the oversight provided by a licensed chiropractor of the clinical
services performed by a licensed chiropractic assistant, and for which the
chiropractor shall be on the premises at all times and readily available to instruct the
licensed chiropractic assistant throughout the performance of the clinical services.
b) Under the supervision of, and when delegated by, a licensed chiropractor, a licensed
chiropractic assistant may perform tasks or functions including, but not limited to, the
following:
1)
Completing a medical history of a patient;
2)
Preparing the patient for chiropractic care;
3)
Writing into the patient record subjective complaints from the patient and objective
findings provided by the licensee;
4)
Performing a urinary dipstick analysis;
5)
Taking and recording vital signs;
6)
Preparing and developing X-ray films;
7)
Providing patient education activities;
8)
Providing instruction in activities of daily living;
9)
Administering cryotherapy, hot packs, non-fulcrum mechanical traction without
restraints (such as roller tables and roller chairs) and non-invasive surface screening;
10)
Setup and preparation of the patient for the administration of physical modalities;
11)
Administering thermal, sound, light, mechanical, and electrical modalities and
hydrotherapy, including, but not limited to, the following:
i. Ultraviolet (B and C bands) or electromagnetic rays including, but not limited to,
deep heating agents, microwave diathermy, short-wave diathermy, and ultrasound;
ii. Electro-therapy devices powered by an alternating current or any interferential
devices, as set forth in (a) above; or
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iii. Decompressing therapy devices or mechanical traction; and
12)
Instructing and monitoring prescribed rehabilitative exercises.
c) Under the supervision of, and when delegated by, a licensed chiropractor, a chiropractic
aide, including a graduate of a recognized program of study in chiropractic, may perform
tasks or functions including, but not limited to, those functions and tasks listed in (b)1
through 10 above. A licensed chiropractor shall not permit a chiropractic aide, including
a graduate of a recognized program to study chiropractic, to perform the tasks listed in
(b)11 and 12 above.
1) If a licensed chiropractor employs a chiropractic aide, the aide is to be supervised by
a licensed chiropractor who shall be on the premises at all times and readily available.
Such supervision shall entail regular consultation, guidance, and instruction with respect
to the tasks and functions performed by the aide.
d) A licensed chiropractor shall not permit a chiropractic aide or licensed chiropractic
assistant to:
1)
Examine, diagnose or analyze a patient;
2)
Notwithstanding (a)1 above, perform massage, unless licensed as a massage and
bodywork therapist in this State by the Board of Massage and Bodywork Therapy
pursuant to N.J.S.A. 45:11-53 to 80.
3)
Take X-rays (unless permitted by license issued by the Department of Environmental
Protection);
4)
Perform a chiropractic adjustment; or
5)
Perform any task or function for which the skill, training, and judgment of a licensed
chiropractor is required to safely and competently perform such task or function.
e) A licensed chiropractor who allows a chiropractic aide or licensed chiropractic assistant
to perform any task or function incidental to the rendering of chiropractic care shall:
1)
Be responsible for the performance of all delegated tasks or functions performed by
such individual;
2)
Supervise the chiropractic aides and licensed chiropractic assistants; and
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3)
Ensure that such individual is competent to perform all delegated tasks or functions.
The licensed chiropractor shall provide any instruction or training necessary to
ensure competence and shall make such inquiry as may be necessary to ensure that
a satisfactory level of education exists so as to conclude that the chiropractic aide
and licensed chiropractic assistant may render any delegated tasks or functions with
reasonable skill and safety.
f) A licensed chiropractor shall write all instructions for duties to be performed by
chiropractic aides and licensed chiropractic assistants in the patient's plan of care and
shall make the plan available at all times to the chiropractic aide and licensed
chiropractic assistant carrying out the instructions.
g) Prior to the performance of any delegated tasks or functions by a chiropractic aide or
licensed chiropractic assistant, the aide or assistant shall determine whether the
patient's physical status has materially changed since the patient's prior office visit. In
such event, the chiropractic aide or licensed chiropractic assistant shall not proceed
with the performance of any delegated tasks or functions until the licensed chiropractor
has reexamined the patient or authorized the performance of a delegated task or
function.
h) Notwithstanding the provisions of (a) through (g) above, a student enrolled in a
chiropractic or chiropractic assistance program approved by the Board may perform
clinical services under the supervision of a licensed chiropractor to gain the necessary
practical clinical experiences.
13:44E-2.7A ORDERING OF ELECTRO-THERAPY DEVICES FOR HOME USE
a) For purposes of this section and N.J.A.C. 13:44E-2.7(c)5ii, "electro-therapy devices"
such as "TENS" (transcutaneous electric nerve stimulation), "MES" (micro-ampere
electric stimulation), or "EMS" (electric muscle stimulation) devices, means devices
which generate an electrical current that is applied to the skin via electrodes to cause a
physiological effect.
b) A licensee may not order an electro-therapy device for home use which:
1)
Uses AC electrical current; or
2)
Is an interferential device which crosses two medium frequency alternating currents
through the body.
c) A licensee may order a battery operated electro-therapy device for home use provided
that the patient:
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1)
Is not using a cardiac pacemaker or implanted defibrillator;
2)
Is not epileptic;
3)
Does not suffer from any cognitive impairment which affects the patient's ability to
follow instructions;
4)
Is willing and able to assume responsibility in writing for use of the electric therapy
device;
5)
Will have adequate home assistance, where such assistance may be necessary in
the opinion of the treating chiropractor, especially when the electrodes are to be
placed paraspinally;
6)
Is provided with a complete set of instructions for home use which includes:
i) The operation of the unit;
ii) Battery charging or changing;
iii) Care of the unit and supplies;
iv) The preferred and alternative electrode placements and stimulation parameters;
v) The suggested schedule of treatment times and rest periods;
vi) Precautions against misuse of the unit, including using the device for any purpose
other than that for which it was ordered;
vii) The avoidance and treatment of skin irritation;
viii) The address and phone number of an information source for troubleshooting; and
ix) The chiropractor's name and phone number; and
7)
Has provided a written acknowledgment that a complete set of instructions for home
use has been received.
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d) A battery operated electro-therapy device may be ordered for home use, provided that
the chiropractor has instructed the patient that the electro-therapy device should not be
applied over:
1)
The carotid sinus;
2)
Blood vessels with thrombosis or emboli;
3)
Tissue or blood vessels vulnerable to hemorrhage or inflammation;
4)
Lumbar or abdominal areas of pregnant women;
5)
The eyes or internally;
6)
A malignancy; or
7)
Trans-thoracic applications in asthenic patients.
e) The licensee shall document the ordering of care using an electro-therapy device in the
patient record pursuant to N.J.A.C. 13:44E-2.2, which shall also include the following:
1)
A specific treatment protocol, including the specific electro-modality to be used, the
electrode type, and the electrode placement;
2)
An evaluation of the patient's response and documentation of any necessary
adjustments to the treatment;
3)
The estimated period of time necessary to achieve the treatment goals of the electro-
stimulation device;
4)
Regular follow-up evaluations of the patient's participation in the at-home electro-
therapy device program; and
5)
The acknowledgment from the patient that a complete set of instructions for home
use has been received pursuant to (c)7 above.
13:44E-2.8 NOTIFICATION OF CHANGE OF ADDRESS; SERVICE OF PROCESS
a) A licensee of the Board of Chiropractic Examiners shall notify the Board in writing of any
change of address from the address currently registered with the Board and shown on
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the most recently issued certificate. Such notice shall be sent to the Board by certified
mail, return receipt requested, not later than 10 days following the change of address.
b) Service of an administrative complaint or other Board-initiated process at a licensee's
address currently on file with the Board shall be deemed adequate notice for the
purposes of N.J.A.C. 1:1-7.1 and the commencement of any disciplinary proceedings.
13:44E-2.9 DISPLAY OF LICENSE
Each person holding a license to practice chiropractic in the State of New Jersey shall
display the license and the current renewal certificate in a conspicuous place in his or her
principal office or place of practice. In addition, the licensee shall display a duplicate issued by
the Board of the current renewal certificate in all other facilities where the licensee practices.
13:44E-2.10 RIGHT TO A HEARING
Prior to any suspension, revocation or refusal to renew a license, the licensee shall have the
right to request a hearing which shall be conducted pursuant to the Administrative Procedure
Act, N.J.S.A. 52:14B-1 et seq., and the Uniform Administrative Procedure Rules, N.J.A.C. 1:1.
13:44E-2.11 OVERUTILIZATION; EXCESSIVE FEES
a) A licensee shall not directly or indirectly engage in the rendering of any bill or the
submission of any claim for service that:
1)
Is not justified by the needs of the patient;
2)
Is for any diagnostic or treatment services, goods or appliances which are excessive
in quality or quantity;
3)
Represents multiple charges for the same chiropractic services or care, goods or
appliances;
4)
Contains an excessive fee. A fee is excessive when, after a review of the facts, a
licensee of ordinary prudence would be left with a definite and firm conviction that the
fee is so high as to be manifestly unconscionable or overreaching under the
circumstances. The charging of an excessive fee shall constitute professional
misconduct pursuant to N.J.S.A. 45:1-21. Factors which may be considered in
determining whether a fee is excessive include, but are not limited to, the following:
i) The time and effort required;
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ii) The novelty and difficulty of the procedure or chiropractic care;
iii) The skill required to perform the procedure or chiropractic care properly;
iv) Any requirements or conditions imposed by the patient or by circumstances;
v) The nature and length of the professional relationship with the patient;
vi) The experience, reputation and ability of the licensee performing the services;
and/or
vii) The nature and circumstances under which services are provided;
5)
Is for services, goods or appliances which were not rendered or supplied; or
6)
Is for a charge or claim which, due to the presence of insurance coverage, exceeds
the usual and customary charges for such services, goods or appliances for patients
who do not have insurance coverage.
13:44E-2.12 REFERRAL OF PATIENTS TO PHYSICAL THERAPISTS
a) A chiropractor providing referral or physician direction for the initiation of physical
therapy treatment by a physical therapist shall supply the physical therapist with the
following information in writing:
1)
The name of the patient;
2)
The printed name of the referring chiropractor, including office address and phone
number;
3)
The signature of the chiropractor and the date;
4)
The purpose of referral (for example, "physical therapy examination and treatment");
and
5)
The spinal component of patient's problem.
b) The referring chiropractor may verbally supply this information provided that a written
confirmation is forwarded to the physical therapist within two weeks.
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c) After the physical therapist has completed the physical therapy examination and
evaluation, the referring chiropractor shall consult with the physical therapist to:
1)
Clarify any divergent assessments that the referring chiropractor and physical
therapist may have made regarding the patient's needs;
2)
Coordinate care and/or treatment programs in the event that the patient receives
concurrent chiropractic and physical therapy. Any such concurrent care and/or
treatment programs shall be compatible; and
3)
Jointly determine a schedule of additional consultation that will allow the referring
chiropractor to monitor the patient's on-going plan of care.
d) The referring chiropractor shall document the initial and on-going consultation with the
physical therapist in the patient's record.
13:44E-2.13 CHIROPRACTIC EXAMINATION
a) To obtain a license to practice chiropractic, a candidate shall successfully pass:
1)
Parts I, II, III and IV of the National Board of Chiropractic Examiners Examination;
and
2)
The New Jersey State Board of Chiropractic Examiners jurisprudence examination.
b) The Board shall hold the New Jersey State Board of Chiropractic Examiners
Jurisprudence Examination no less than twice per year at a date, time, and place
designated by the Board.
c) An applicant licensed in another state who seeks licensure by endorsement shall
successfully pass the written jurisprudence examination administered by the New
Jersey State Board of Chiropractic Examiners.
13:44E-2.14 INDEPENDENT CHIROPRACTIC EXAMINATIONS
a) For the purposes of this section, "independent chiropractic examination" means the
taking of a history and the performance of a clinical examination of a patient conducted
in this State by a chiropractor, other than the attending chiropractor, at the request of a
third party, for the purpose of evaluating the patient's current condition and the
preparation of a written report.
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b) A chiropractor performing an independent chiropractic examination in the State of New
Jersey shall:
1)
Hold a valid license to practice chiropractic in the State of New Jersey pursuant to
N.J.S.A. 45:9-41.8 or 45:9-41.10; and
2)
Have at least two years of clinical experience post-licensure if licensed after August
2, 2004.
c) A licensed chiropractor performing an independent chiropractic examination shall:
1)
Complete a patient record pursuant to N.J.A.C. 13:44E-2.2;
2)
Document in the patient record and report the nature and extent of records reviewed
including other information presented such as results of diagnostic imaging and/or
diagnostic testing;
3)
Perform and document in the patient record and in any resulting report, a history,
clinical examination and a chiropractic analysis or diagnosis, pursuant to N.J.A.C.
13:44E-1.1(b), that includes the specific tests, examinations or observations
performed, and the results and evaluation of these specific tests, examinations or
observations together with a review of the patient's response to prior care.
4)
Document the clinical rationale for an opinion expressed with respect to the patient's
present condition in the patient record and report;
5)
Not make any recommendations directly to the patient for alterations in care by the
attending chiropractor except with respect to the advice required by N.J.A.C. 13:44E-
2.2(f)3. If such advice of an abnormality or condition is given to the patient and
referral to another health care professional is recommended, such findings shall be
documented in the patient record and report;
6)
Not solicit the patient for care; and
7)
Author and sign the independent chiropractic examination report.
13:44E-2.15 PERMISSIBLE PRACTICE STRUCTURES
a) As used in this section, the following words and terms shall have the following
meanings, unless the context clearly indicates otherwise.
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"Board" means the New Jersey State Board of Chiropractic Examiners.
"Chiropractic physician" means a chiropractor holding a license issued by the Board.
"Closely allied health care professional" means an individual who provides professional
services and is licensed or certified in New Jersey by a professional or occupational
licensing board or other State agency, in any of the following fields: medicine or its
branches; dentistry; podiatry; physical therapy; occupational therapy; nursing;
acupuncture; or psychology.
"D.O." means a Doctor of Osteopathy holding an active plenary license to practice
medicine and surgery issued by the New Jersey Board of Medical Examiners.
"Employee" means a chiropractic physician who is employed, for any form of
remuneration, by one of the permissible practice structures under (b) below or in a
general business corporation as set forth in (c) below, whether the chiropractic physician
is denominated as an employee or independent contractor.
"Limited liability company" (LLC) means a limited liability company formed under the laws
of this State pursuant to the New Jersey Limited Liability Company Act, N.J.S.A. 42:2B-1
et seq., except where inconsistent with these rules.
"M.D." means a Medical Doctor holding an active plenary license to practice medicine
and surgery issued by the New Jersey Board of Medical Examiners.
"Permissible business structure" means a sole proprietorship, partnership, limited liability
company or a professional service corporation, all of which are subject to the limitations
of (b) and (c) below.
"Professional service" means services rendered by a health care professional within the
scope of their practice authorized by their State professional board.
"Professional service corporation" means a business entity established pursuant to
N.J.S.A. 14A:17-1 et seq., in which all shareholders are chiropractic physicians or closely
allied health care professionals.
b) The following are permissible business structures that may offer chiropractic
professional services in the State of New Jersey:
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1)
A sole proprietorship consisting of one chiropractic physician or the chiropractic
physician may employ or otherwise may remunerate other closely allied health care
professionals, except an M.D. or D.O., to render professional services within the
scope of practice of each employee's license. The chiropractic physician may employ
ancillary non-licensed staff in accordance with applicable Board rules, if any, and
accepted standards of practice;
2)
A partnership in which all partners are chiropractic physicians or a combination of
chiropractic physicians and closely allied health care professionals; however, the
partnership may not employ an M.D. or D.O., unless at least one partner is an M.D.
or D.O.;
3)
A corporation established consistent with the provisions of the Professional Service
Corporation Act, N.J.S.A. 14A: 17-1 et seq., in which all shareholders are chiropractic
physicians or a combination of chiropractic physicians and closely allied health care
professionals; however, the professional service corporation may not employ an M.D.
or D.O., unless at least one shareholder is an M.D. or D.O.; and
4)
An LLC in which all members are chiropractic physicians or a combination of
chiropractic physicians and closely allied health care professionals; however, the LLC
may not employ an M.D. or D.O., unless at least one member is an M.D. or D.O.
c) A chiropractic physician may offer chiropractic services as an employee of a general
business corporation in this State only in one or more of the settings in (c)1 through 6
below. Any such setting shall have a designated chiropractic or medical director,
licensed to practice chiropractic or medicine in this State, who is regularly on the
premises and who, alone or with other persons authorized by the State Department of
Health, if applicable, is responsible for verification of licensure and credentialing of
chiropractic providers and the provision of chiropractic services. The settings are as
follows:
1)
The corporation or other business entity is licensed by the New Jersey Department of
Health as a health maintenance organization, hospital, long-or short-term health care
facility, ambulatory care facility or other type of health care facility or health care
provider such as a diagnostic imaging facility. This may include a licensed facility that
is a component part of a for-profit corporation employing or otherwise remunerating
licensed health care professionals;
2)
The corporation or other business entity is not in the business of offering treatment
services to the public, but maintains a medical or chiropractic clinic for the purposes
of providing services directly to employees and/or monitoring the medical or
chiropractic health of employees. The provisions of N.J.A.C. 13:44E-2.2 regarding
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the preparation, maintenance and release of chiropractic patient records shall apply
to persons receiving care or evaluation in this setting;
3)
The corporation or business entity is a non-profit corporation sponsored by a union,
social or religious or fraternal-type organization providing chiropractic services to
members only. The provisions of N.J.A.C. 13:44E-2.2 regarding the preparation,
maintenance and release of chiropractic patient records shall apply to persons
receiving care or evaluation in this setting;
4)
The corporation or other business entity is an accredited educational institution that
provides medical or chiropractic services to students and/or faculty. The provisions of
N.J.A.C. 13:44E-2.2 regarding the preparation, maintenance and release of
chiropractic patient monitoring records shall apply to persons receiving care or
evaluation in this setting;
5)
The corporation or other business entity is licensed by the New Jersey State
Department of Banking and Insurance as an insurance carrier offering coverage for
chiropractic services and the licensee is employed to perform quality assurance or
utilization review services for the insurance carrier; or
6)
The corporation or other business entity is employed by, or under contract to, an
insurance carrier or managed care plan offering coverage for chiropractic services to
provide quality assurance or utilization review services.
d) Chiropractic physicians shall only be employed in a permissible practice structure as set
forth in (b)1 through 4 above or under the exceptions set forth in (c)1 through 6 above.
e) Chiropractic physicians may be employed by a permissible business structure, which
includes one or more closely allied health care professionals, including at least one
chiropractic physician, M.D. or D.O., provided that the professional practice is
supervised by at least one chiropractic physician, M.D. or D.O.
f) If the scope of practice authorized by law for each closely allied health care professional
differs, any document used in connection with the professional practice including, but
not limited to, professional stationery, business cards, advertisements or listings and
bills shall designate the field to which each closely allied health care professional's
practice is limited.
g) Notwithstanding (a) through (d) above, chiropractic physicians shall not engage in the
practice of chiropractic, as a sole proprietor, partner, shareholder, member, or employee
in any permissible business structure in which they are shielded from liability for their
own breaches of professional duties, fail to retain responsibility for the quality of care
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and appropriateness of professional judgments, or are not assured access to
information and involvement in issues pertaining to quality of care, professional
judgment, recordkeeping, advertising practices, billing for services rendered and, except
for employees, the finances of the permissible business structure.
h) Notwithstanding (a) through (d) above, a chiropractic physician who is a member,
employee, agent or representative of an LLC shall remain personally responsible for his
or her own negligence, wrongful acts or misconduct and that of any person under his or
her direct supervision and control while rendering professional services on behalf of an
LLC in this State to the person for whom such professional service was being rendered.
i) Any violation of (b) through (h) above shall be deemed professional misconduct
pursuant to N.J.S.A. 45:1-21(e).
SUBCHAPTER 3.
DETERMINATIONS WITH RESPECT TO THE VALIDITY OF CERTAIN
DIAGNOSTIC TESTS, SPECIAL REQUIREMENTS FOR ELECTRODI
AGNOSTIC TESTS AND OTHER SPECIAL EXAMINATIONS
13:44E-3.1 DEFINITIONS
As used in this subchapter, the following words and terms shall have the following meanings,
unless the context clearly indicates otherwise.
"Board" means the New Jersey State Board of Chiropractic Examiners.
"Chiropractic physician" means a chiropractor holding a license issued by the New Jersey
State Board of Chiropractic Examiners.
Clinically supported" means that a chiropractic physician, prior to selecting, performing or
ordering the administration of a diagnostic test, has:
1.
Personally performed a physical examination, making an assessment of any current
and/or historical subjective complaints, observations, objective findings, or neurological
indications;
2.
Considered any and all previously performed tests relating to the patient's clinical
condition and the results; and
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3.
Documented in the patient record positive and negative findings, observations and clinical
indications to justify the test.
"Diagnostic test" means a professional service utilizing biomechanical, neurological,
neurodiagnostic, radiological, vascular or any means, other than bioanalysis, intended to
assist in establishing a diagnosis, for the purpose of recommending a course of treatment for
the tested patient to be implemented by a chiropractic physician or other treating practitioner.
"Electrodiagnostic test" means a diagnostic test utilizing electrical current to measure and
record electrical irritability, but is not intended to include surface electromyography (SEMG).
"Medical doctor" means an allopathic or osteopathic physician holding a plenary license
issued by the New Jersey State Board of Medical Examiners.
"Normal" or "normally" means the usual, routine, customary or common experience and
conclusion, which may in unusual circumstances differ from the actual judgment or course of
treatment. The unusual circumstances shall be based on clinically supported findings of a
chiropractic physician. The use of these terms is intended to indicate some flexibility and
avoid rigidity in the application of these rules and to recognize the good faith educated
judgment of a chiropractic physician.
"Practitioner" means a licensee of a professional board authorized to render health care
services, including, but not limited to, chiropractic physicians, medical doctors, podiatric
physicians, physical therapists and registered professional nurses.
"Significant beneficial interest" means any financial interest but does not include ownership
of a building wherein the space is leased to a person at the prevailing rate under a straight
lease agreement or any interest held in publicly traded securities.
"Special examination" means a diagnostic test, other than electrodiagnostic test, that is not
routinely utilized by chiropractic physicians in the course of ordinary practice, such as
specialized imaging studies or vestibulo-ocular-nystagmus tests. "Special examination" does
not include x-rays, computer-supported range of motion testing, applied kinesiology, gait
analysis, postural analysis tests or muscle testing devices, such as Dynatron or Cyber
station.
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13:44E-3.2 RECOGNIZED DIAGNOSTIC TESTS; PERMISSIBLE BILLING
a) Consistent with the scope of practice, upon the attainment of education and training in
the pertinent test and, with respect to electrodiagnostic tests or special examinations, a
certificate of competency, a chiropractic physician may perform a diagnostic test and
charge a patient or third party payor for that test, except as provided by (b) and (c)
below.
b) A chiropractic physician shall not bill for any diagnostic tests that have not been reliably
demonstrated to identify conditions amenable to chiropractic care beyond the
information ascertainable from the taking of a patient history and performance of a
thorough clinical examination or that otherwise fail to yield data of sufficient clinical
value in the development, evaluation or implementation of a plan of treatment, including
the following:
1)
Spinal diagnostic ultrasonography/ultrasound imaging of the spine;
2)
Current perception threshold tests;
3)
Iridology;
4)
Reflexology; or
5)
Surrogate arm mentoring.
c) A chiropractic physician may bill for any of the following diagnostic tests, which have
recognized reliability and validity and can yield data of sufficient clinical value in the
development, evaluation or implementation of a plan of treatment, when clinically
supported, subject to the limitations noted:
1)
Repetitive stimulation studies and nerve conduction studies inclusive of motor,
sensory, F-wave and H-reflex studies;
2)
Somasensory evoked potential (SSEP), visual evoked potential (VEP), auditory
evoked potentials (AEP), brainstem auditory evoked potential (BAEP) and
dermatome evoked potential, or brain evoked potential (BEP) where the extent of
response to treatment is not otherwise sufficiently ascertained from subjective reports
and by objective findings or other diagnostic tests;
3)
Thermography only when used to evaluate pain associated with reflex sympathic
dystrophy ("RSD") in a controlled setting;
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4)
Videofluroscopy only in the evaluation of hypo-mobility syndrome and wrist/carpal
hypo-mobility, where there are findings of no range or aberrant range of motion or
dysymmetry of facets;
5)
Surface EMG;
6)
Applied kinesiology and gait analysis; and
7)
Computer-supported range of motion tests, postural analysis tests or muscle testing
devices, such as Dynatron or Cyber station; and
8)
Vestibulo-ocular-nystagmus tests.
d) Notwithstanding any limitations set forth in (b) above, a chiropractic physician may
perform the enumerated diagnostic test, after assuring that written informed consent has
been obtained from the patient, but in no case shall the patient or third party payor be
billed or charged for the test.
13:44E-3.3 REFERABLE TESTS
a) A chiropractic physician shall not perform the following, but may refer a patient to an
appropriately trained medical doctor for the purpose of undergoing:
1)
Needle electromyography (needle EMG) for the evaluation and diagnosis of
neuropathies and radicular syndrome where clinically supported findings reveal a
loss of sensation, numbness or tingling; or
2)
Any test requiring administration of medication for effective performance.
13:44E-3.4 BASIC PRE-TEST PREREQUISITES AND STANDARDS FOR PATIENT
EVALUATION APPLICABLE TO ELECTRO-DIAGNOSTIC TESTS AND SPECIAL
EXAMINATIONS
a) A chiropractic physician performing or interpreting electrodiagnostic tests and special
examinations shall:
1)
Adhere to accepted standards of practice applicable to the performance of such tests
relating to clinical justification, reliability, validity, performance technique,
interpretation and integration into the plan of treatment;
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2)
Ensure that tests, if performed by a chiropractic physician, are performed personally
or under his or her immediate personal supervision and direction;
3)
Assure that professionally responsible and scientifically sequential pre-testing
determinations are followed;
4)
Take and document, in the patient's record, a relevant history of the complaints
presented by the patient. Chiropractic records shall meet acceptable clinical
standards and contain such pertinent information including height, weight, past
medical and surgical history and other information that may influence the outcome or
interpretation of the testing;
5)
Perform, at a minimum, a problem-focused examination;
6)
Establish and document in the patient's record, a provisional diagnosis with clinical
correlation; and
7)
Abide by appropriate standards of informed consent explaining potential risks,
potential benefits and other clinical options.
b) A chiropractic physician requesting the performance of electrodiagnostic tests and other
special examinations with respect to a specific patient shall first:
1)
Take and document in the patient record a history of the patient's clinical condition,
reflecting:
i) Responses to inquiries regarding prior disease, trauma, surgery, prior and current
medications prescribed by other practitioners, use of orthopedic devices and
other relevant information, as applicable to the patient's situation;
ii) Factors which may be contributing to the patient's pain, sensory or motor
complaints; and
iii) Pertinent information such as the patient's current height and weight, employment
(including physical requirements, whether in or outside the home) and relevant
aspects of required work effort, known injuries, testing performed and results,
care received, response and other factors which may be relevant to the patient's
condition;
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2)
Perform and document in the patient record a clinical examination including
subjective complaints, observations, objective findings from a neurologically oriented
physical examination, tests performed and their results including x-ray interpretation,
interpretive reports of imaging studies acquired from any source, and interpretive
reports of any other testing;
3)
Establish and document in the patient record a provisional diagnosis and plan of
care;
4)
Prepare and document in the patient record ongoing progress notes reflecting
subjective complaints, objective findings, treatment provided, and the patient's
objective and subjective response to the treatment provided; and
5) Discuss with the patient appropriate alternatives and options, including referral to
another practitioner or specialist for consultation and evaluation.
c) A chiropractic physician who has complied with the requirements of (b)1 through 5
above may request electrodiagnostic tests or special examinations if the results of tests
selected are expected to:
1)
Alter the course of the patient's treatment;
2)
Aid in determining the extent of functional deficit present; and
3)
Be useful in the assessment of deterioration or improvement of a condition for the
purpose of continued care.
d) A chiropractic physician who has complied with the requirements of (b)1 through 5
above may refer a patient to another chiropractic physician or other appropriately
licensed and trained practitioner to determine the need for, and the performance and
interpretation of, an electrodiagnostic test or a special examination by means of a
request for professional consultation, provided the referring chiropractic physician:
1)
Thoroughly documents in the patient record an appropriate scientific rationale for the
referral; and
2)
Directly communicates with the practitioner who is to perform the test, prior to the
referral, as is professionally appropriate in the circumstances.
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13:44E-3.5 EDUCATIONAL PREREQUISITES APPLICABLE TO
ELECTRODIAGNOSTIC TESTS AND SPECIAL EXAMINATIONS; CERTIFICATE
REQUIREMENT
a) A chiropractic physician seeking to perform electrodiagnostic tests and special
examinations shall:
1)
Be trained and skilled in the knowledge of:
i) The physiology and topographical anatomy of the peripheral and trunk
musculature and of the peripheral and central nervous systems;
ii) Pathology as contrasted with normal presentation of peripheral nerve and muscle
tissue;
iii) Clinical presentation of various neurological disorders and of neuropathological
dysfunction of central and peripheral pathways and in the treatment protocols of
tests pertinent to such conditions;
iv) Electrodiagnosis as pertinent to an understanding of instrumentation and
laboratory parameters for the testing and interpretation of the test in question;
v) Laboratory hygiene and aseptic technique to prevent transmission of infectious
diseases;
vi) Technical procedures necessary to ensure proficiency in performance of the test
to be utilized; and
vii) The precepts of ethical practice so as to limit test utilization to the patient's best
interests;
2)
Successfully complete (and retain certification of completion of) a Board-approved
course consisting of course work and practical, hands-on instruction and an
examination that demonstrates that the chiropractic physician is capable of
recognizing scientifically supportable and practical indications of the test; possesses
skill at proper interpretation of the test; and has obtained training in how to integrate
the test results into management of the patient’s condition. The course shall be:
i) Provided on the premises of an accredited college recognized by the New Jersey
State Board of Chiropractic Examiners;
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ii) Received in a postgraduate program sponsored by a college of chiropractic
recognized by Council of Chiropractic Education; or
iii) Provided at an accredited medical school or licensed health care facility; and
3) Within 60 days of completion of a course referred to in (a)2 above, submit to the Board
a completed application form for certification to perform the test or examination sought,
together with the onetime certification fee set forth in N.J.A.C. 13:44E-2.5, which the
Board shall act upon within 90 days of its receipt.
b) A chiropractic physician performing or offering to perform electrodiagnostic tests or
special examinations shall comply with the applicable standards of accepted practice for
practitioners engaged in like professional conduct. A chiropractic physician performing
or offering to perform electrodiagnostic testing who does not fully comply with all
requirements set forth in this section may be found to be engaging in misrepresentation,
deception, gross or repeated malpractice or negligence or incompetence, professional
misconduct, and/or any other disciplinary ground authorized by applicable law or rules.
c) A chiropractic physician seeking to utilize experimental equipment or procedures for
research purposes shall:
1)
Secure the prior written approval of the Board;
2)
Obtain the informed consent of the patient; and
3)
Not charge or bill the patient or third party payor for the service.
d) A chiropractic physician performing electrodiagnostic tests or special examinations shall
familiarize himself or herself with contemporary professional journals and with scholarly
texts to maintain current accepted standards of practice in the profession and in the
specialty.
13:44E-3.6 INFORMED CONSENT; EQUIPMENT; PREPARATION FOR AND
PERFORMANCE OF THE ELECTRODIAGNOSTIC TEST OR SPECIAL EXAMINATION
a) The chiropractic physician performing an electrodiagnostic test or special examination
shall provide the patient with a written description of the test addressing the risks
involved in disorders in homeostasis, infectious diseases, and contraindications for
electrodiagnostic testing, for example, the presence of a pacemaker, if pertinent.
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b) A chiropractic physician performing any electrodiagnostic test or special examination
shall ensure that all equipment used in the performance of electrodiagnostic tests and
special examinations:
1)
Is capable of performing its designated task efficiently, for the benefit to the patient;
2)
Is maintained in proper working order to assure safety; and
3)
Is inspected, at least once each year (or more frequently if required by law or
recommended by the manufacturer) to maintain quality of performance and
calibration, with documentation of such inspections retained for seven years from the
date of last entry, or until disposal of the equipment.
c) A chiropractic physician performing an electrodiagnostic test or special examinations
shall:
1)
Personally perform a physical examination which examination also specifically
focuses on the orthopedic neuromuscular condition for which the testing has been
recommended;
2)
Ascertain the reliability and validity of the testing performed;
3)
Consider repeat testing only when:
i) Prior results or current findings are indicative of a deteriorating condition that
warrants subsequent monitoring;
ii) The results of the initial test was justifiably suspect; or
iii) There is a change in the patient's clinical condition;
4)
Document the decision-making process in the patient record; and
5)
Provide a report as required by N.J.A.C. 13:44E-3.8 to the practitioner who requested
the performance of the electrodiagnostic test or special examination.
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13:44E-3.7 USE OF TESTING ASSISTANT
a) When using an assistant or other person, whether or not licensed in a health care
profession, to provide technical assistance in performance of an electrodiagnostic test
or special examination, a chiropractic physician shall:
1)
Ascertain the assistant's competence;
2)
Review the appropriateness and quality of services provided by the assistant;
3)
Remain in the room during the performance of the test;
4)
Make all professional decisions with respect to the testing;
5)
Directly supervise the testing at all times;
6)
Not be involved in the concurrent testing or supervision of testing of another patient;
and
7)
Assure that the tasks performed by the assistant are fully documented in the patient
record, along with the person's full name legibly printed.
b) If any fee, other than a regular salary paid to an employee, has been or shall be paid by
the chiropractic physician to an assistant or other person, directly or indirectly, a full
record of such fee and the basis therefor shall be prepared and maintained for seven
years, and shall be subject to inspection by the State Board of Chiropractic Examiners,
the Attorney General, or by the Director of the Division of Consumer Affairs.
13:44E-3.8 PREPARATION OF TEST REPORT; FOLLOW-UP
a) A chiropractic physician who performs an electrodiagnostic test or special examination
shall:
1)
Prepare and retain a comprehensive report, on professional letterhead bearing the
chiropractic physician's full name and license number, office name, address and
telephone number, which report shall include at least the following:
i) The patient's name, case identification number, age, sex, height and weight, and
dominant side;
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ii) The date on which the test was performed;
iii) The location at which the test was performed;
iv) The date on which the report was prepared;
v) A description of the relevant clinical history, including the patient's problem and
indication for the testing including the presenting symptoms and clinical signs,
etiology of symptoms, history of other diagnostic tests performed and their
outcomes;
vi) An identification of the specific test(s) performed and, if applicable, a full
description of nerves or muscles sampled, acquisition parameters, appropriate
technical attributes of the study such as limb temperature, sites of stimulation,
recording of amplitudes and response, latency, configuration of wave forms,
distances and velocities, as well as the criteria utilized to identify the reported
abnormality;
vii) Data relevant to the test performance, reported in a manner such that another
appropriately trained practitioner would be able to interpret the results or replicate
the procedure;
viii) Interpretation and comments regarding normality or abnormality of the data which
reflects the clinical significance of the data and describes the differential
diagnosis and potential etiology for the findings made; and
ix) A statement of diagnostic conclusions and recommendations for appropriate
treatment, to include referral to another specialist, if appropriate;
2)
Ensure that if technical difficulties were encountered, the report addresses those
difficulties, including but not limited to, artifact production, non-compliance or
agitation by the patient, edema, presence of deformity or scar tissue; and
3)
Retain, as part of the patient record, any raw data or graphs arising out of a
diagnostic test administration in a form that shall be:
i) Appropriate to the test utilized, for example, copies of wave forms from nerve
conduction studies and evoked potentials; and
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ii) Available for hard copy review or submission to the Board request, as required by
N.J.A.C. 13:44E-2.2.
b) A chiropractic physician who has requested an electrodiagnostic test or special
examination shall obtain from the practitioner who performed the test, in addition to the
interpretive report required in (a) above, a representative sample of the wave forms or
other raw data, as applicable to the particular test, for inclusion in the patient record.
c) A chiropractic physician who has performed an electrodiagnostic test or special
examination shall discuss the findings and recommendations with the patient or patient's
representative, as applicable.
d) A practitioner who requested that a chiropractic physician perform electrodiagnostic test
or special examination may request, with the patient's consent, a second opinion from
another licensed chiropractic physician or medical doctor, trained and skilled in the
performance and interpretation of electrodiagnostic tests. The patient shall not be
caused to incur an additional charge for the second opinion unless the patient
specifically consents or the patient's insurance carrier approves such expense as may
be incurred. If the consultant to whom the patient is referred intends to charge for the
consultation, neither that consultant nor the referring chiropractic physician shall have a
significant beneficial interest in the practice of the other.
13:44E-3.9 LIMITATIONS ON REFERRALS
a) A chiropractic physician requesting that another chiropractic physician or other
practitioner perform any diagnostic tests shall:
1)
Comply with the limitations on lawful referral set forth in N.J.S.A. 45:9-22.4 et seq.;
2)
Not refer a patient to another practitioner practicing at the same premises or at any
space within or outside of the office or building, parking lot or other area in any
mobile premises in the environs of the office or building, unless:
i) The patient record fully justifies the recommendation for evaluation;
ii) That other practitioner is a bona fide partner, fellow shareholder of a professional
service corporation or other permitted practice structure, or a regularly salaried
practitioner-employee of the chiropractic physician requesting the performance of
a diagnostic test; and
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iii) The bill for professional services reflects the name of the practice entity and
identity of the provider of service.
b) Nothing in this section is intended to prevent a chiropractic physician from referring a
patient to another practitioner for consultation.
13:44E-3.10 FEES
a) The chiropractic physician performing a diagnostic test for which a charge is authorized,
prior to performance of any such test, shall ensure:
1)
That the patient has been informed of the anticipated fee for the professional service
in a timely manner sufficient to allow the patient, who has the ultimate responsibility,
to ascertain the financial responsibility for the procedure;
2)
That the fee, whether global or totaled for both technical and professional
components, be billed solely under the name of the chiropractic physician performing
the test, or his/her office, consistent with billing practices applicable to other
chiropractic services; and
3)
That the fee shall not violate N.J.A.C. 13:44E-2.11, which prohibits excessive fees.
13:44E-3.11 APPLICATION OF PROHIBITIONS AND LIMITATIONS
Prohibitions or limitations on the permissible performance of tests as designated in this
subchapter, or regarding billing for tests previously performed, shall be prospective with regard
to rule compliance, but shall not limit the Board's authority to enforce the provisions of N.J.S.A.
45:1-14 et seq. and other applicable law and rules.
SUBCHAPTER 4.
LICENSED CHIROPRACTIC ASSISTANTS
13:44E-4.1 PURPOSE AND SCOPE; EFFECTIVE DATE
a) The rules in this subchapter implement the provisions of P.L. 2015, c. 283, concerning
the licensure of chiropractic assistants.
b) The provisions in this subchapter shall take effect on November 7, 2018.
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13:44E-4.2 DEFINITIONS
As used in this subchapter, the following words and terms shall have the following meanings
unless otherwise noted:
“Board” means the New Jersey State Board of Chiropractic Examiners.
“Chiropractic assistance” means assisting a licensed chiropractor by providing certain
clinical procedures common and customary to the chiropractic setting pursuant to N.J.S.A. 45:9-
41.9(c) and N.J.A.C. 13:44E-4.3
“Licensed chiropractic assistant” means a person holding a license issued by the New
Jersey State Board of Chiropractic Examiners to practice chiropractic assistance under the
supervision of a licensed chiropractor. A person licensed as a chiropractic assistant may use
that full title or its abbreviation, “L.C.A.”
“Plan of care” means a documented treatment plan designed by the licensed chiropractor
for the treatment of a patient.
“Supervision” means the oversight provided by a licensed chiropractor of the clinical
services performed by a licensed chiropractic assistant and for which the chiropractor shall be
on the premises at all times and readily available to instruct the licensed chiropractic assistant
throughout the performance of the clinical services.
13:44E-4.3 SCOPE OF PRACTICE
a) The scope of practice of a licensed chiropractic assistant includes, but is not limited to,
the following:
1. Collection of general health data including:
i. Taking of an oral history or vital sign measurement;
ii. Performing manual muscle tests, general orthopedic and neurologic tests, and
functionality and outcome assessment tests; and
iii. Other testing that qualifies as part of chiropractic assistance;
2. Application of thermal, sound, light, mechanical, and electrical modalities and
hydrotherapy including, but not limited to, the following:
i. Ultraviolet (B and C bands) or electromagnetic rays including, but not limited to,
deep heating agents, microwave diathermy, short-wave diathermy, and ultrasound;
ii. Electro-therapy devices powered by an alternating current or any interferential
devices, as set forth in N.J.A.C. 13:44E-2.7(a); and
iii. Decompression therapy devices or mechanical traction, including non-fulcrum
mechanical traction without restraint;
3. Instructing and monitoring prescribed rehabilitative activities, including:
i. Recording a patient’s response to treatment based on subjective and objective
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findings; and
ii. Reporting to the licensed chiropractor who developed the plan of care for treatment
of the patient on:
A. Any response to or lack of progress with treatment; and
B. The need for program change, reassessment of treatment, or discontinuation of
treatment.
b) A licensed chiropractic assistant’s work shall not include:
1. Non-clinical administrative work;
2. Chiropractic adjustment;
3. Manual therapy;
4. Nutritional instruction;
5. Counseling; and
6. Other therapeutic services or procedures requiring additional licensure.
13:44E-4.4 LICENSING REQUIREMENTS
a) To be eligible for licensure as a chiropractic assistant in New Jersey, an applicant shall:
1. Be at least 18 years old;
2. Be of good moral character;
3. Have successfully completed high school or its equivalent;
4. Have successfully completed the education and clinical requirements set forth in
N.J.A.C. 13:44E-4.6;
5. Submit a completed application;
6. Have successfully passed a Board-approved competency examination; and
7. Have paid the required fees pursuant to N.J.S.A. 45:9-41.34(d) and N.J.A.C. 13:44E-
4.16.
13:44E-4.5 LICENSURE ELIGIBILITY; EXCEPTIONS
a) The term “chiropractic assistant” or any other title, designation, words, letters,
abbreviations, or insignia indicating the practice of chiropractic assistance shall only be
used by an individual if that person is licensed to practice chiropractic assistance under
the provisions of N.J.S.A. 45:9-41.33 et seq. (P.L. 2015, c.283).
b) Students enrolled in an educational program, recognized by the Board, that leads to a
degree or certification as a chiropractic assistant, shall be permitted to provide clinical
services under the supervision of a chiropractor to gain the necessary practical clinical
experience.
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13:44E-4.6 EDUCATION REQUIREMENTS
a) An applicant for licensure as a chiropractic assistant shall satisfy the following
educational requirements earned from a chiropractic institution accredited pursuant to
N.J.S.A. 45:9-41.6:
1. 120 hours of didactic education, obtained through live and recorded webinars and live
classroom instruction, to include the following:
i. Chiropractic philosophy and terminology;
ii. Functional anatomy of the spine, extremities, muscles, nerves, and landmarks;
iii. Management of common disorders;
iv. Rehabilitation;
v. Physiotherapy modalities including indications and contraindications;
vi. Professional behavior related to ethics, boundaries, and risk management;
vii. Documentation and recordkeeping; and
viii. Hygiene;
2. 380 hours of clinical training consisting of the following monitored activities:
i. Health data collection;
ii. Examination and testing procedures;
iii. Passive and active therapeutic interventions;
iv. Documentation and recordkeeping; and
v. Patient safety and office policies regarding emergency procedures; and
3. A Board-administered examination on New Jersey jurisprudence.
b) The completion of the clinical training in (a)2 above shall be accompanied by
documented attestation and notarization to demonstrate the satisfactory completion of
clinical requirements under supervision of the licensed chiropractor.
13:44E-4.7 APPLICATION FOR LICENSURE
a) An applicant for licensure as a licensed chiropractic assistant in New Jersey shall submit
the following to the Board:
1. A completed application form provided by the Board which shall contain the
applicant's name, address, Social Security number, academic qualifications, information
from other states regarding licensure, certification or registration, resume, questions
demonstrating moral character, confidential questions concerning the applicant's fitness
to practice and child support questions;
2. Official transcripts demonstrating completion of the educational requirements
pursuant to N.J.A.C. 13:44E-4.6;
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3. Proof of successful completion of a Board-approved competency exam pursuant to
N.J.A.C. 13:44E-4.4(a)6;
4. The application fee set forth in N.J.A.C. 13:44E-4.16; and
5. A certification of authorization to perform and cooperate in a criminal history
background check conducted pursuant to N.J.S.A. 45:1-28 et seq.
13:44E-4.8 ISSUANCE OF LICENSES; LICENSE RENEWALS
a) Licenses to practice chiropractic assistance shall be issued for a period of two years and
be renewed biennially. A licensed assistant who seeks renewal of his or her license shall
submit a license renewal application and the license renewal fee set forth in N.J.A.C.
13:44E-4.16 to the Board prior to the expiration of the current license.
b) If a licensed assistant does not renew his or her license prior to its expiration date, they
may renew the license within 30 days of its expiration by submitting a renewal application,
a license renewal fee and a late fee, as set forth in N.J.A.C. 13:44E-4.16.
c) A license that is not renewed within 30 days of its expiration date shall expire. Any
individual who continues to practice chiropractic assistance with an expired license after 30
days following the license expiration date shall be deemed to be engaged in unlicensed
practice.
13:44E-4.9 CONTINUING EDUCATION
a) "Licensee," as used in this section, means a chiropractic assistant licensed and subject
to regulation by the Board of Chiropractic Examiners.
b) A licensee applying for biennial license renewal shall have completed, during the
preceding biennial period, 15 continuing educational credits in order to qualify for the
renewal of his or her license, pursuant to N.J.S.A. 45:9-41.35. One credit is defined as
50 minutes of instruction. A minimum of two credits shall be completed in the study of
State laws and rules governing professional ethics of chiropractic assistance or
recordkeeping and documentation as it pertains to the practice of chiropractic
assistance in this State.
c) The continuing education courses may include, but not be limited to, subject matter and
content of study that is taught by accredited chiropractic schools, colleges, institutions,
and universities, or in a subject matter tested for licensure, that has been approved by
Providers of Approved Continuing Education (PACE) and/or the Board; except that the
Board retains the right to reject any PACE-approved program that does not have
significant intellectual or practical content dealing primarily with matters directly related
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to the practice of chiropractic assistance or with professional responsibilities or ethical
obligations of licensees.
d) The Board will not grant continuing education credit for completion of basic courses
required for graduation for training as a licensed chiropractic assistant or for initial
licensure. Continuing education credit shall be granted only for courses designed to
build upon basic knowledge and/or to bring licensees up-to-date on new developments
relating to the practice of chiropractic assistance.
e) The Board may accredit other educational programs offered by professional
organizations or societies, health care professions, schools, colleges, institutions,
universities or healthcare facilities as suitable for continuing education credits, so long
as such other educational programs have significant intellectual or practical content,
which deal primarily with matters directly related to the practice of chiropractic
assistance or with the professional responsibilities or ethical obligations of licensees.
f) The Board may accredit other equivalent educational programs including, but not limited
to, examinations, scientific papers, professional publications, scientific presentations,
residency programs, teaching and/or research appointments, advanced degree or
certification program in related fields, scientific exhibits, independent study or research,
or self-study programs, or distance learning as suitable for continuing education credits,
so long as such other educational programs have significant intellectual or practical
content, which deal primarily with matters directly related to the practice of chiropractic
assistance or with the professional responsibilities or ethical obligations of licensees.
g) Continuing education credit shall be calculated as follows:
1. Continuing professional education programs of national or State professional
organizations: one credit hour for every 50 minutes of in-class participation;
2. Accredited university or college courses in the subjects set forth in (d) above:
i. Applicants shall receive 7.5 credit hours of continuing education credit for each
semester or trimester credit hour earned; five credit hours of continuing education
credit for each credit hour earned in a quarter; and
ii. Applicants attending noncredit courses shall be granted continuing education
credit at the rate of one credit hour for every 50 minutes of in-class participation;
3. Distance learning programs and other independent study programs: the amount of
credit to be allowed for approved distance and individual study programs, including
taped study programs, shall be one credit hour for every 50 minutes of distance and
individual self-study program participation;
4. Teaching or instruction of a course for the first time or teaching a course previously
taught if substantial time was spent updating course material: instruction and
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preparation time: one continuing education credit for each hour of instruction or
preparation.
i. The total number of continuing education credits that may be granted for service
as a teacher or instructor shall not exceed six credits per biennial period.
ii. Requests for credit shall be accompanied by an outline of the instruction or
course.
iii. A teacher or instructor that is employed as a teacher or instructor on a full-time
basis shall not be eligible to obtain continuing education credits for such activities;
5. Scientific papers and professional publications: credit shall be given for each 50-
minute period of preparation time on a self-declaration basis, not to exceed six credit-
hours per biennial period. A copy of the publication article shall be submitted to the
Board with a request for continuing education credit.
i. Credit may be claimed for published articles and books by the authors of those
works. These publications must contribute to the professional competency of
chiropractors.
ii. In exceptional circumstances, a licensee may request additional credit by
submitting the article or book to the Board with an explanation of the circumstances
that he or she believes justifies an award of greater credit. When licensees request
more than six continuing education credit hours earned through papers and
publications during the biennial period, credit hours awarded shall be determined by
the Board on a case-by-case basis. Factors such as complexity of the subject matter,
length of publication, and the amount of preparation time shall be considered;
6. Research and preparation of examinations or acting as an examiner for a clinical
examination: one continuing education credit for each hour of research or time spent on
the examination, not to exceed three continuing education credits per biennial period;
and
7. Scientific presentations or exhibits: one continuing education credit for each hour of
preparation or presentation, not to exceed six continuing education credits per biennial
period.
(h) A licensee shall complete no more than six of the total continuing chiropractic
assistance education credits by asynchronous distance learning courses where the
instructor and the learner are not in direct, live communication during the course,
approved by the Board; the remaining credits must be attained through live didactic
learning experience, including synchronous distance learning activities where the
instructor and learner are in direct live communication during the course. The Board
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shall not award more than eight hours of continuing education credit for any program
that takes place during the course of one calendar day.
(i) A provider seeking Board approval to sponsor programs for continuing education credit
shall submit an application to the Board, which shall include course and program
descriptions, instructor qualifications, locations, dates and times of courses, and other
information as required by the Board.
1. Qualified sponsors shall offer courses that meet the following criteria:
i. Be a formal course of learning, which contributes directly to the maintenance of
professional competence of a licensee;
ii. Be at least one credit hour, 50-minute period, in length; however additional
credits in excess of one hour may be awarded in 1/2 hour increments;
iii. Be conducted by a qualified instructor or discussion leader; and
iv. Offer subjects enumerated in (c) above.
2. A continuing education sponsor may receive prior approval, valid for the current
biennial licensing period in which the approval was issued, for a course of acceptable
subject matter, as set forth in (c) above, and be assigned a designated number of
continuing education credits by the Board if the program sponsor provides in writing
information required by the Board to document the elements of (i)1 above, and in
addition, certifies that the sponsor shall:
i. Maintain and retain accurate records of attendance for a five-year period;
ii. Retain a written outline of course materials for a five-year period; and
iii. Comply with the requirements of (i)4 below.
3. The Board will post on its website at
http://www.njconsumeraffairs.gov/chiro/chiro_licensee.htm a list of all program sponsors
that, pursuant to this section, have applied and have been approved to sponsor courses
for continuing education credit. Continuing education sponsors shall comply with the
following additional requirements:
i. The program sponsor shall disclose in advance to prospective participants the
objective, prerequisites, experience level, content, required advanced preparation,
teaching method, and number of continuing education credits involved in the
program;
ii. The program sponsor shall provide evidence to the Board that it has policies and
procedures in place to verify and adequately monitor the attendance of course
participants;
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iii. The program sponsor shall be responsible for assuring that the number of
participants and the physical facilities are consistent with the teaching methods to be
utilized;
iv. The program sponsor shall select and assign qualified instructors for the
continuing education program. Sponsors shall provide to the Board the curriculum
vitae of all course instructors and certify to the Board that the sponsor has verified
the credentials of all its instructors. Sponsors must notify the Board of any instructor
change within 20 days of making the change;
v. The program sponsor shall evaluate the performance of its program instructors at
the conclusion of each program to determine the instructors' suitability to continue to
serve as instructors in the future;
vi. Program evaluation shall be in accordance with the following:
(1) The sponsor shall provide some means of program evaluation. Evaluations
shall be solicited from both the participants and instructors. Programs shall be
evaluated to determine whether:
(A) Objectives were met;
(B) Prerequisites were necessary or desirable;
(C) Facilities were satisfactory;
(D) The instructor was effective;
(E) Advanced preparation materials were satisfactory; and
(F) The program content was timely and effective; and
(2) Evaluations shall take the form of one or a combination of pre-tests for
advanced preparation, post-tests for effectiveness of the program, questionnaires
completed at the end of the program or later, or oral feedback to the instructor or
sponsor. Instructors shall be informed of their performance and sponsors shall
systematically review the evaluation process to insure its effectiveness; and
vii. The program sponsor shall be responsible for issuing certificates of satisfactory
completion or other comparable documentation to program participants. Such
certificates or documentation shall be printed with the following information:
(1) Dates attended;
(2) Credit hours earned;
(3) Course title and description of content, including the method of course delivery
and subject area;
(4) Course sponsor name;
(5) Instructor name; and
(6) Course location.
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4. A continuing education sponsor who has qualified as a sponsor, or has obtained prior
Board approval, shall not alter, amend, update, or reconfigure the approved courses for
continuing education credit without the permission of the Board. If a continuing education
sponsor alters, amends, updates, or reconfigures a course, the continuing education
sponsor must resubmit the course to the Board for approval.
j) A licensee seeking Board approval of a program for continuing education credit, which has
not been approved pursuant to (i) above, may submit an application on a form prescribed by
the Board, which shall include course and program descriptions, instructor qualifications,
locations, dates and times of courses, number of continuing education credits, and other
information as required by the Board. The Board shall notify the licensee, in writing, of its
determination, which is based upon (d), (e), and (f) above.
k) A new licensee who completed an accredited graduate chiropractic assistant education
program within 12 months of the commencement of the biennial registration period is not
required to complete the continuing education requirements for the biennial period.
l) A licensee shall certify on the application for biennial licensure renewal that he or she has
completed the required number of continuing education credits. The Board may conduct
random audits to determine licensee compliance with the continuing education requirements of
this section.
m) A licensee who completes more than 15 continuing chiropractic education credits required
pursuant to this section may apply no more than three of the excess credits to the continuing
chiropractic education requirements for the following biennial period only. The excess credits
approved for a biennial period may be applied to the continuing education requirements for the
next period whether or not approved for that period.
n) Licensees holding an inactive or retired license shall be exempt from continuing education
requirements, except that any licensee holding an inactive or retired license, or whose license
is suspended or revoked, who applies to resume practice as a licensed chiropractic assistant
shall provide proof of having completed the continuing chiropractic assistance education
requirements for each biennial licensure period for which the licensee was on inactive or
retired status. If the total credits required to become current exceeds 15, then 15 shall be the
maximum number required. Any applicant seeking to resume practice shall submit to the
Board a detailed list of all continuing education courses that the licensee has completed in
order to become current. If the Board determines that there is a deficiency in a particular area
of study, the Board may require the applicant to complete additional continuing education
courses in the area of the deficiency before reinstating the license to active status.
o) To report continuing chiropractic assistance education credits, a licensee shall:
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1. Certify, on the application for biennial renewal, completion of the required number of
continuing education credits; and
2. Maintain all evidence of completion of continuing education requirements for a period
of not less than five years after satisfaction of the credits and submit such
documentation to the Board upon request.
p) The Board may extend the time period for completion of continuing education requirements
or may waive continuing education requirements on an individual basis for reasons of
hardship, such as severe illness, disability or military service, consistent with the following:
1. A licensee seeking an extension or waiver of the continuing education requirements
shall apply to the Board in writing setting forth the specific details for the reasons why
an extension or a waiver is requested. The licensee shall submit all of the
documentation that supports the request for the extension and/or waiver;
2. A licensee shall apply for an extension and/or a waiver prior to the expiration of the
biennial renewal period. All requests shall be sent to the Board office, by certified mail,
return receipt requested; and
3. An extension or waiver granted pursuant to this section shall become effective for the
biennial licensure period in which the extension or waiver is granted. If the condition that
necessitated the extension or waiver continues into the next biennial period, the
licensee shall apply to the Board for the renewal of such extension or waiver for the new
biennial period.
q) A licensee shall provide verification and proof of compliance with continuing chiropractic
education requirements. Non-compliance with the continuing education requirements shall
provide cause for civil penalties pursuant to N.J.S.A. 45:9-41.32.
r) A second or subsequent offense by a licensee for failure to comply with the continuing
education requirements may be considered professional misconduct and would provide
grounds for additional discipline including license suspension or revocation.
13:44E-4.10 DISPLAY OF LICENSURE
Each person holding a license to practice as a chiropractic assistant in the State of New
Jersey shall display the license and a current renewal certificate in a conspicuous location in the
principal place of business where he or she is employed as a licensed chiropractic assistant.
13:44E-4.11 NOTIFICATION OF CHANGE OF ADDRESS; SERVICE OF PROCESS
a) A licensed chiropractic assistant shall notify the Board in writing of any change of address
from the address currently registered with the Board and shown on the most recently
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issued certificate. Such notice shall be sent to the Board by certified mail, return receipt
requested, not later than 10 days following the change of address.
b) Service of an administrative complaint or other Board-initiated process at a licensed
assistant’s address currently on file with the Board shall be deemed adequate notice for
the purposes of N.J.A.C. 1:1-7.1 and the commencement of any disciplinary proceedings.
13:44E-4.12 OPPORTUNITY TO BE HEARD
Prior to any suspension, revocation, or refusal to renew a license, the licensed assistant shall
have the opportunity to be heard pursuant to the Administrative Procedures Act, N.J.S.A.
52:14B-1 et seq., and 52:14F-1 et seq., and the Uniform Administrative Procedures Rules,
N.J.A.C. 1:1.
13:44E-4.13 SUPERVISION
a) A licensed chiropractic assistant shall only initiate treatment when a supervising licensed
chiropractor is on the premises.
b) In a practice with more than one licensed chiropractor, a supervising licensed
chiropractor is to be designated for that office. In his or her absence, a licensed
chiropractor in that same practice shall be designated temporarily until the initial
designee returns.
13:44E-4.14 PLAN OF CARE; RECORDKEEPING
(a) A licensed chiropractic assistant shall follow the plan of care designed for a patient’s
treatment by a licensed chiropractor.
(b) Licensed chiropractic assistants shall make contemporaneous, permanent entries into
professional treatment records which shall accurately reflect the treatment or service
rendered as listed in the plan of care. To the extent applicable, professional treatment
records shall reflect:
1) Dates and times of interaction with a patient;
2) Identifying and documenting specific elements of each physiotherapy
modality provided, including:
i. Time or other details to be included in a plan of care;
ii. Equipment used during session or provided to the patient; and
iii. Length of time for each treatment relating to therapeutic modalities or
rehabilitative care;
3) Care provided without the co-signature of the supervising chiropractor; and
4) Patient progress and status at discharge in the chiropractic record according to
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office policies.
13:44E-4.15 SEXUAL MISCONDUCT
a)
By this section, the New Jersey State Board of Chiropractic Examiners is identifying for
licensed chiropractic assistants conduct that it shall deem to be violative of the law.
b)
As used in this section, the following terms have the following meanings unless the
context indicates otherwise:
1. “Licensee” means any person licensed to engage in the practice of chiropractic
assistance as regulated by the New Jersey State Board of Chiropractic Examiners.
2. “Patient” means any person who is the recipient of a professional service rendered by
a licensee for the purposes of care relating to chiropractic assistance.
3. “Patient-chiropractor assistant relationship” means an association between a
chiropractic assistant and patient wherein the licensee owes a continuing duty to the
patient to be available to render professional services consistent with his or her
chiropractic assistance training and experience. The performance of any professional
chiropractic assistance includes, but is not limited to, any consultation and care provided
by a licensee in furtherance of chiropractic assistance care.
4. “Sexual contact” means the knowing touching of a person’s body directly or through
clothing, where the circumstances surrounding the touching would be construed by a
reasonable person to be motivated by the licensee’s own prurient interest or for sexual
arousal or gratification. “Sexual contact” includes, but is not limited to, the imposition of a
part of the licensee’s body upon a part of the patient’s body, sexual penetration, or the
insertion or imposition of any object or any part of a licensee’ or patient’s body into or
near the genital, anal, or other opening of the other person’s body. “Sexual contact” does
not include the touching of a patient’s body that is necessary during the performance of
a generally accepted and recognized chiropractic assistant technique.
5. “Sexual harassment” means solicitation of any sexual act, physical advances, or
verbal or nonverbal conduct that is sexual in nature and which occurs in connection with
a licensee’s activities or role as a provider of chiropractic assistant services, and that
either: is unwelcome, offensive to a reasonable person, or creates a hostile workplace
environment, and the licensee knows, should know, or is told this; or is sufficiently
severe or intense to be abusive to a reasonable person in that context. “Sexual
harassment” may consist of a single extreme or severe act or of multiple acts and may
include, but is not limited to, conduct of a licensee with a patient, co-worker, employee,
or student whether or not such individual is in a subordinate position to the licensee.
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6. “Spouse” means the husband, wife, or fiancée of the licensee or an individual involved
in a long-term committed relationship with the licensee.
i. For purposes of this section, a long-term committed relationship means a
relationship that is at least six months in duration.
c) A licensee shall not engage in sexual contact with a patient with whom he or she has a
patient-licensed chiropractic assistant relationship. That relationship is considered ongoing
for purposes of this section, unless:
1. Professional services are terminated by written notice to the patient from the
chiropractor working with the licensed assistant via certified mail, return receipt
requested, and documentation in the patient record; and
2. Three months have elapsed since the last professional service was rendered.
d) A licensee shall not seek or solicit sexual contact with a patient with whom he or she has
a patient-chiropractic assistant relationship and shall not seek or solicit sexual contact with
any person in exchange for professional services.
e) A licensee shall not engage in any discussion of an intimate sexual nature with a patient,
unless that discussion is related to legitimate patient needs. Such discussion shall not
include disclosure by the licensee of his or her own intimate sexual relationships.
f) A licensee shall provide privacy and conditions that prevent the exposure of the unclothed
body of the patient unless necessary to the professional chiropractic assistant services being
rendered.
g) A licensee shall not engage in sexual harassment in a professional setting while
performing in a professional capacity.
h) A licensee shall not engage in any other activity that would lead a reasonable person to
believe that the activity serves the licensee’s personal prurient interests or is for the sexual
arousal or sexual gratification of the licensee or patient or that constitutes an act of sexual
abuse.
i) Violation of any of the prohibitions or directives set forth at (c) through (h) above shall be
deemed to constitute professional misconduct pursuant to N.J.S.A. 45:1-21(e).
1. The patient solicited or consented to sexual contact with the licensee; or
2. The licensee was in love with or had affection for the patient.
13:44E-4.16 FEE SCHEDULE
a) The following fees shall be charged by the Board:
1. Application fee - $125.00
2. Endorsement fee - $75.00
3. Initial licensing fee:
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i. During the first year of a biennial renewal period - $150.00
ii. During the second year of a biennial renewal period - $75.00
4. Biennial license renewal fee - $150.00
5. Duplicate license fee - $25.00
6. Verification of licensure fee - $40.00
7. Late renewal fee - $50.00
8. Reinstatement fee - $125.00 (plus all past due license fees); and
9. Inactive license fee - $50.00