Part 1. General Information

   1.1 Purpose
   1.2 Business Location
   1.3 Board Members and Officers
   1.4 Regular, Special and Emergency Meetings
   1.5 Laws that Govern the Board
   1.6 Board Rules
   1.7 Complaint Procedure

Part 2. Information for Applicants

   2.1 Need for a License
   2.2 Where to Request an Application
   2.3 How to Qualify for a License by Taking an Examination
   2.4 How to get a License by Endorsement
   2.5 Registration of Chiropractic Interns
   2.6 Right to a Written Decision
   2.7 Right to Appeal

Part 3. Information for Licensed Chiropractic Physicians

   3.1 Renewing a License
   3.2 Reinstatement
   3.3 Change of Name or Address
   3.4 Professional Standards and Penalties
   3.5 Adjunctive Therapies

Part 4. Continuing Professional Education

   4.1 Continuing Professional Education Requirement for Renewal of Licenses
   4.2 Approval of Continuing Education Programs
   4.3 Continuing Professional Education Records

Part 5. Competency Requirements of Licensees

   5.1 Competency Requirements of Licensees Under 26 V.S.A. § 525

Part 6. Minimal Record Keeping Standards

   6.1 Minimal Record Keeping Standards



PART 1.   GENERAL INFORMATION

1.1 PURPOSE

The Board of Chiropractic (which is referred to as "the Board" in this rule) has been created and given powers by Vermont law. Its purpose is to protect the public health, safety and welfare. It does this by setting standards for issuing licenses, licensing only qualified applicants and regulating practices of license holders.

1.2 BUSINESS LOCATION

The Board's business location is the Office of the Secretary of State, Office of Professional Regulation, 26 Terrace Street, Montpelier, Vermont, (the "Office"). Its mailing address is

Board of Chiropractic
Office of the Secretary of State
Office of Professional Regulation
26 Terrace Street, Drawer 09
Montpelier, Vermont 05609-1106

1.3 BOARD MEMBERS AND OFFICERS

The Board is composed of three chiropractic physicians who are graduates of a recognized school of chiropractic, and two public members. Each member has been appointed by the governor for a five year term. A member may not serve more than two consecutive terms on the Board. Officers are elected once a year.

1.4 REGULAR, SPECIAL AND EMERGENCY MEETINGS

The chair or a majority of the members may call a special or emergency meeting if it is necessary. Three members of the Board constitute a quorum for all meetings; formal action may be taken at a meeting if a majority of those present and voting are in favor of the action.

Information on meetings can be obtained from the Office.

1.5 LAWS THAT GOVERN THE BOARD

The Board is governed by Chapter 10, Title 26, Vermont Statutes Annotated, which establishes the Board`s responsibilities for setting standards, issuing licenses and regulating the profession. In addition, the Board is obligated to comply with several other state laws such as the "Administrative Procedure Act" (3 V.S.A. §§801-849), the "Right to Know Law" (1 V.S.A. §§312-314), the "Access to Public Records Law" (1 V.S.A. §§315-320), and the "Law of Professional Regulation" (3 V.S.A. §§ 121-131). These laws set forth the rights of an applicant, license holder or member of the public.

The complete text of these laws is available at most libraries and town clerk's offices. "Vermont Statutes Online" are also available on the Internet at http://www.leg.state.vt.us. The Board's statutes and rules may also be accessed through the Board's Web site at http://www.vtprofessionals.org.

1.6 BOARD RULES

The Board's rules have the effect of law and govern its proceedings. In making rules, the Board must follow the Administrative Procedure Act ("Act"). The provisions of the Act dealing with rulemaking are in 3 V.S.A. §§801-849. The Office helps the Board comply with the Act. The Board reviews its rules periodically and revises them as needed.

1.7 COMPLAINT PROCEDURE

The Office maintains a procedure for receiving complaints, conducting investigations and instituting and conducting disciplinary proceedings. The Board follows the current version of the procedure, as it may be amended from time to time.

PART 2.   INFORMATION FOR APPLICANTS
2.1 NEED FOR A LICENSE

No person may practice chiropractic in Vermont without being currently licensed by the Board.

2.2 WHERE TO REQUEST AN APPLICATION

Applications and more information about the types of licenses and their requirements are available from the Office.

2.3 HOW TO QUALIFY FOR A LICENSE BY TAKING AN EXAMINATION

Applicants for a license by examination must have reached the age of majority, graduated from an accredited school of chiropractic, and passed the Board's written and practical examinations. An "accredited school of chiropractic" is one approved by an association which is recognized by the United States Department of Education for accreditation of programs of chiropractic education, not for accreditation of institutions.

The application packet includes instructions for filing. The completed application, including supporting documents, must be received 45 days before a regularly scheduled examination for the applicant to be seated for that examination.

Applicants who do not pass the practical examination may review the results with the Board. No other appeal of a failing grade is available. Applicants who failed only one part may retake that part of the examination one time. In all other cases, failing candidates must retake the full examination. A fee is charged for each retake.

Applications may be denied if the applicant has engaged in unprofessional conduct.

2.4 HOW TO GET A LICENSE BY ENDORSEMENT

Applicants who are licensed and in good standing in another state may apply for a license without written examination. The applicant must have graduated from an accredited school of chiropractic and must pass the practical examination. See Rule 2.3 for clarification of accreditation and the policy on retaking the practical examination.

Applications may be denied if the applicant has engaged in unprofessional conduct.

2.5 REGISTRATION OF CHIROPRACTIC INTERNS

A fourth year chiropractic student may be registered as an intern and practice under supervision of a licensed chiropractor. A licensed chiropractor must personally observe the intern when the intern is performing the chiropractic acts described in 26 VSA § 521(3).

An applicant for registration must show current enrollment in an accredited school of chiropractic and must provide an agreement to supervise from a licensed chiropractor. Each licensed chiropractor who provides observation for the intern's practice must file an observer's statement with the Board.

2.6 RIGHT TO A WRITTEN DECISION

All decisions to grant or deny a license are made in writing, giving the specific reasons for denial. A decision to deny a license is not final until the applicant has had an opportunity to appear before the Board and show why the license should be issued.

2.7 RIGHT TO APPEAL

A final decision of the Board may be appealed to an appellate officer, who will review the record made before the Board for legal errors. Persons wishing to appeal must give written notice of their decision to appeal within 30 days of receipt of the Board's final decision to:

Director, Office of Professional Regulation
> Office of the Secretary of State
26 Terrace Street, Drawer 09
Montpelier, Vermont 05609-1106

The appellate officer's decision may be appealed to Washington Superior Court.

PART 3.  INFORMATION FOR LICENSED CHIROPRACTIC PHYSICIANS
3.1 RENEWING A LICENSE

Licenses are issued for a two-year period, and must be renewed by the expiration date printed on the license certificate. The Office mails renewal notices in advance of the expiration date. A licensee is responsible for renewal whether a notice is received or not, and a license is not valid after its expiration.

3.2 REINSTATEMENT

A lapsed license may be reinstated within three years of expiration upon payment of the renewal fee and late renewal penalty.

After three years, a new application must be filed and application fee paid. The applicant must take, or have taken within the preceding three years, the Special Purpose Examination for Chiropractors, or if not eligible for the Special Purpose Examination for Chiropractors, the Board's practical examination.

3.3 CHANGE OF NAME OR ADDRESS

A licensee is responsible for notifying the Office of any change of name or address.

3.4 PROFESSIONAL STANDARDS AND PENALTIES

Under 26 V.S.A. § 522, a person can be imprisoned for up to a year or fined from $500 to $5,000, or both, for practicing chiropractic without a license.

In addition, under 26 V.S.A. § 541, the Board may refuse to issue or renew a license or suspend or revoke a license for unprofessional conduct, which is more specifically defined in § 541 and in 3 V.S.A. § 129a.

3.5 ADJUNCTIVE THERAPIES

Adjunctive therapies are therapies a chiropractor may use in addition to chiropractic adjustment to treat patients. Chiropractors may use adjunctive therapies in which they have been adequately trained. Adjunctive therapies for chiropractic are physiotherapy modalities, rehabilitative exercises, nutritional therapy, massage techniques and acupuncture. Adjunctive therapy includes the use of topically applied therapeutic agents incident to any of the above listed therapies.

PART 4.   CONTINUING PROFESSIONAL EDUCATION 4.1 CONTINUING PROFESSIONAL EDUCATION REQUIREMENTS FOR RENEWAL OF LICENSES

A licensee seeking regular biennial renewal shall show that he or she has completed no fewer than 24 hours of approved continuing professional education during the two-year period preceding renewal.

Applicants for renewal of licenses shall file with their applications a signed statement verifying the continuing professional education programs for which they claim credit, showing:

- sponsoring organization;
- location of program;
> - title of program or description of content;
- dates of attended; and
- hours claimed.

For applicants granted an initial license to practice by the Board, accumulation of continuing education hours shall commence on the opening date of the first biennial renewal period following grant of initial licensure.

The Board may conduct random audits to verify completion of continuing education up to four years after a license is renewed. Upon request by the Board, the licensee shall submit certificates of completion for all programs listed in the licensee's renewal application.

A licensee who fails to comply with continuing education requirements may be required to develop and complete a specific corrective action plan of remedial coursework within 90 days, prior to license renewal. See 3 V.S.A. § 129k. This means that the plan must be submitted to the Board and the coursework must be completed within the 90-day corrective period. The Office will extend the license during the 90-day corrective period but will not renew it if the licensee fails to complete the plan.

Upon a showing of hardship, the Board may waive the continuing education requirement. To apply for waiver, the licensee must submit a written statement not less than 60 days before expiration of the license renewal period setting forth the conditions of hardship with specificity. After review, the Board shall send written notification of its decision, and the reasons therefor, to the licensee.

4.2 APPROVAL OF CONTINUING EDUCATION PROGRAMS

Standards - A program meets Board qualifications if it is a formal course of learning which contributes to the growth of professional knowledge and competence of an individual in the practice of chiropractic. In its discretion, the Board may designate in advance not more than 12 hours in a specific subject area or areas related to public health and safety in which licensees will be required to obtain continuing education credit during the succeeding two-year license renewal period. In exercising its discretion, the Board will apply the following standards: (1) there must be a demonstrated general need for licensees to acquire and maintain competence in the specific subject area or areas, including but not limited to an increase in complaints of unprofessional conduct in the specific subject area or areas, (2) the Board must be assured that continuing education courses in the specific subject area or areas are reasonably available to licensees, and (3) the Board must review any such designation prior to expiration of the two-year license renewal period to ascertain whether the designation should remain in place or should be removed.

Credit - continuing professional education credit will be given for whole hours only, with a minimum of 50 minutes constituting one hour. As an example, 100 minutes of continuous instruction would count only as two hours; however, more than 50 minutes but less than 100 minutes of continuous instruction would count only as one hour. Only time spent in instruction, and not preparation time, will be credited. For university or college courses, each semester hour of credit shall equal 15 hours toward the requirement, and a quarter hour of credit shall equal 3.75 hours.

Case-by-case approval - Individual course may be approved upon submitting to the Board a course outline, instructor qualifications, sponsoring organization, and dates of presentation. Advance approval is not required.

Blanket approval - Courses in the following categories are approved without further action by the Board:

- Postgraduate courses in core curriculum subjects offered for credit by a CCE-accredited school;

- Courses approved for continuing education credit by chiropractic boards of other states where the participant is licensed and practicing;

- Courses approved for continuing education credit toward category I of the Physician's Recognition Award of the American Medical Association, provided that such courses do not exceed 12 hours in a biennial renewal period.

Unacceptable courses - Approval will not be granted for the following types of courses:

- Courses in practice management;
> - Courses in financial management;
- Courses in chiropractic philosophy.

Auditing - Sponsors of programs who apply for approval to the Board thereby consent to auditing of the program by a Board member or designee at no charge.

4.3 CONTINUING PROFESSIONAL EDUCATION RECORDS

Responsibility for documenting the acceptability of the program and the validity of the credits rests with the applicant. Such documentation should be retained for a period of seven years after the completion of the program. Such documentation may consist of the following:

- Copy of the course outline prepared by the course sponsor along with the information required by Rule 4.1.

- For courses taken for scholastic credit in accredited universities and colleges, evidence of satisfactory completion of the course will be sufficient; for non-credit courses, a statement of the hours of attendance, signed by the instructor, is required.

PART 5.   COMPETENCY REQUIREMENTS OF LICENSEES
5.1 COMPETENCY REQUIREMENTS OF LICENSEES UNDER 26 V.S.A. § 525

This Board rule sets forth the standards and requirements for the special license endorsement permitting licensees to apply ionizing radiation to human beings for diagnostic purposes.

Twenty-six V.S.A. § 525 authorizes the Board to require a licensee to demonstrate competency before applying ionizing radiation to human beings for diagnostic purposes. All such licensees shall be subject to the following standards and requirements.

All users shall complete a program of radiography self-study determined by the Board. This shall include but not be limited to the generation of x-rays and gamma rays and their interaction with matter, principles of radiography, shielding and film processing. This self-study program shall be completed at initial licensing.

Users who make plain radiographs shall file a biennial report on forms provided by the Board, which shall include the type and age of the film screen systems and frequency of cleaning; technique charts; repeat rate, including the leading three causes; type of equipment and date of most recent inspection or calibration; method of processing (if automatic processor, type, age and frequency of cleaning; if hand processing, frequency of change of chemicals); annual number of exams and types of exams; names and license numbers of all persons applying ionizing radiation; and verification of fluoroscopy capability and use or lack of use.

A Board evaluator shall visit premises as the Board deems necessary to conduct a competency evaluation. The evaluation shall include but not be limited to quality control evaluation (random film evaluation for collimation, film blackening, positioning, appropriate patient shielding, and processing; review of method of documentation of last menstrual period (LMP)); report of equipment type, including film/screen combinations; and report on evaluation of processor chemicals and cleanliness of chemicals if manual processing technique used.

The evaluation shall also include a quality control check of films selected randomly for diagnostic quality of film and quality control (collimation, processing, and appropriate patient shielding).

An ionizing radiation endorsement must be renewed every two years and a renewal fee must be paid. The licensee is responsible for renewing on time. An ionizing radiation endorsement not renewed by the expiration date will expire automatically. To reinstate an ionizing radiation endorsement after it has expired, a licensee must apply to the Board for approval and pay the required fee.

The Board or its designee will perform competency evaluations on not less than 10 percent of its licensees actively practicing in Vermont per biennial renewal period. Licensees will be selected for such evaluations on a random basis. The Board or its designee will contact the licensee before the evaluation and will schedule the evaluation within 60 days. If violations are found during the evaluation, a re-evaluation may be conducted on the basis of advance announcement or may be conducted without advance announcement to the licensee. The Board will not assess an evaluation fee more than once in any two-year period against any licensee.

A licensee may be fined up to $5,000 or imprisoned for up to one year, or both, if he or she applies ionizing radiation to human beings for diagnostic purposes without first having obtained from the Board the necessary special license endorsement to do so. The Attorney General or a State's Attorney may bring a civil action to enjoin continuing violations of the law.

PART 6.   MINIMAL RECORD KEEPING STANDARDS

6.1 MINIMAL RECORD KEEPING STANDARDS

These rules apply to all licensed chiropractic physicians during the normal course of care with new or established patients, regardless of whether the fee for services was charged, reduced, or waived by means of advertisement or otherwise.

Chiropractic records are maintained to serve as a basis for planning patient care and for continuity in the evaluation of a patient's condition and treatment; to furnish documentary evidence of the course of the patient's clinical evaluation, treatment, and change in condition; and to document communication between the practitioner responsible for the patient and any other health care professional who contributes to the patient's care.

Chiropractic records shall be legibly maintained and shall contain sufficient information to identify the patient; support the diagnosis/assessment; substantiate the treatment; and document the course and results of treatment accurately by including, at a minimum, patient histories, examination results, test results, records of substances dispensed, administered, or recommended, reports of consultations and hospitalizations, and copies of records or reports or other documentation obtained from other health care practitioners at the request of the physician and relied upon by the physician in determining the appropriate treatment of the patient.

Initial and follow-up services (daily records) shall consist of documentation of current status and treatment rendered.

All patient records shall include patient history; condition presented or wellness care, or both; and examination findings, including x-rays when clinically indicated. Abbreviations may be used in a patient's record, provided that the record also contains a legend or key explaining the meaning of any abbreviations used.

A licensed chiropractic physician must provide copies of a patient's records within 30 days, when the chiropractic physician receives a written request for the records from the patient, the patient's representative, or succeeding health care professionals or institutions. This rule applies to patient records which are in the possession of or under the control of the chiropractic physician.



Effective: June 1, 2001