(1) The usual and customary fee that a Doctor of Chiropractic charges for services is a personal privilege.
(2) Each licensee shall maintain a schedule of fees charged for common services and the schedule of fees shall be available to patients upon request. The billing procedure must be fully explained to the patient orally and in writing. Licensees shall make certain that each patient is informed about the charging and billing procedures of the licensee's office prior to any charges being incurred.
(3) If licensees agree to bill third party payors on behalf of their patients, licensees must bill third party payors at the same rate the patient was billed and the bill must accurately reflect any discount that was given to the patient.
(4) It is not unethical for licensees to charge interest on time payments of past due accounts, if the billing procedure is fully explained to the patient orally and in writing and complies with other applicable laws. The monthly rate of interest must be printed on the statement.
(5) Licensees may offer free or reduced cost services to any patient of their choice. However, it is the licensees responsibility to comply with other applicable federal and state laws regarding billing practices.
Stat. Auth.: ORS 684
Stats. Implemented: ORS 684.155(b)
Hist.: 2CE 1-1978, f. 6-16-78, ef. 7-1-78; CE 1-1991, f. & cert. ef. 10-21-91
Pre-Paid and Contracted Treatment Plans
A Pre-Paid Plan is a package of services and/or products that are purchased by patients at a reduced or discounted cost than if the services were purchased individually.
(1) Chiropractic physicians may accept pre-payment for services planned but not yet delivered only if they do so in such a way that it does not constitute the practice of insurance.
(a) “Insurance” is defined as a contract whereby one undertakes to indemnify another or pay or allow a specified or ascertainable amount or benefit upon determinable risk contingencies (ORS 731.102).
(b) Chiropractic physicians or clinics who are certified by the Oregon Department of Insurance as Medical Retainer Plans are exempted from this section.
(c) These plans must not be in violation of OAR 811-015-0000 (Fees).
(2) Pre-Paid and Contracted Treatment Plans must include the following, in writing:
(a) The total costs/fees that the patient will incur and the method and timing of payment(s).
(b) Description of what services and products are included and excluded — If nutritional products or other hard goods including braces, supports or patient aids are to be used during the proposed treatment plan, the patient documents must state whether these items are included in the gross treatment costs or if they constitute a separate and distinct service and fee. Any additional fees must be explained to the patient in advance and noted in the chart notes.
(c) Description of the time frame which the plan covers.
(d) How special circumstances, such as extended absences, new injury or illness are handled.
(e) Statement that there is no claim or representation of a guarantee of results, outcome, or the cure of a particular condition.
(3) Early Termination of Care:
(a) The pre-payment plan must include a written explanation on how the unused portion of funds are calculated or prorated should the patient complete care early or discontinue care due to the patient’s choice, doctor’s choice, moving, or new injury, or condition. The written explanation must be clearly labeled “Refund Policy” and explained in plain language that is understood by the patient. The explanation must include a table of calculations that illustrates the amount of refunds or amount owed in the event of the pre-paid plan’s early termination.
(b) The patient may have the right to terminate the Pre-Pay Plan at any time: In event of early termination of a pre-paid treatment plan by the patient, the maximum fee charged cannot exceed the chiropractor's usual and customary fee cash pay (including any time of service discount) for the services rendered.
(c) The chiropractic physician may terminate the Pre-Pay Plan at any time, for good and sufficient cause, except licensee must ensure that patient abandonment does not occur. In event of early termination of a pre-paid treatment plan by the chiropractic physician or clinic, the maximum fee charged cannot exceed pro-rated fees as agreed upon in the pre-paid treatment plan.
(4) Pre-Pay Plans must be in compliance with all other applicable State or Federal Laws.
Stat. Auth.: ORS 684
Hist.: BCE 3-2010, f. & cert. ef. 6-15-10; BCE 2-2013, f. & cert. ef. 8-2-13
(1) Failure to keep complete and accurate records on all patients shall be considered unprofessional conduct
(a) Each patient shall have exclusive records which shall be clear, legible, complete and accurate; as to allow any other Chiropractic physician to understand the nature of that patient's case and to be able to follow up with the care of that patient if necessary.
(b) Every page of chart notes will identify the patient by name and one other unique identifier (date of birth, medical record number, etc.), and the clinic of origin by name and address. Each entry will be identified by day, month, year, provider of service and author of the record.
(c) Clear, legible, complete and accurate records contain the following:
(A) A description of the chief complaint or primary reason the patient sought treatment from the licensee.
(B) Documentation of any significant event that affects the chief complaint of the patient or the general history of the health of the patient.
(C) An accurate record of the diagnostic and therapeutic procedures that the licensee has employed in providing chiropractic services to the patient, including, but not limited to:
(i) Examinations and the results of those examinations;
(iii) Treatment plan, and any subsequent changes to the treatment plan and the clinical reasoning for those changes;
(iv) Dates on which the licensee provided clinical services to the patient, as well as the services performed and clinical indications for those services;
(v) Areas of the patient’s body where the licensee has provided care;
(vi) Patient’s response to treatment;
(vii) Therapeutic procedures must be clearly described including information such as providers involved, timing, setting and tools used as appropriate.
(D) Relevant information concerning the patient such as height, weight, and blood pressure.
(E) Documentation of informed consent for examination and treatment.
(F) Other clinically relevant correspondence including but not limited to telephonic or other patient communications, referrals to other practitioners, and expert reports.
(d) A chiropractic physician shall maintain billing records for services performed for which payment is received from or billed to the patient, an insurance company, or another person or entity who has assumed the financial responsibility for the payment of services performed to the patient. Such records will be maintained for same amount of time as other patient records. As a minimum, a billing record will include the date of the patient encounter or financial entry, a notation of the services performed either by description or code, common codes such as the AMA Current Procedural Terminology (CPT) codes may be used without additional explanation or legend, and the fee charged for the services billed. If third party payers are billed, the billing instrument (CMS 1500 form or its successor) should be retrievable. Such information may be maintained on a handwritten or printed ledger, with the assistance of a computer or other device either by direct entry or with a particular program or application, or by an alternative method. To the extent billing records do not contain patient health care records not kept elsewhere, they are not consider part of the clinical record.
(e) Such information as described in section (d) must be readily available upon request of the patient, an agent of the patient, an insurance carrier or entity responsible for the payment of the services, or by the Board or other entity with a legal right to review such information.
(2) Practitioners with dual licenses shall indicate on each patient's records under which license the services were rendered.
(3) A patient's original health care and billing records shall be kept by the chiropractic physician a minimum of seven years from the date of last treatment. However, if a patient is a minor, the records must be maintained at least seven years from the time they turn 18 years of age.
(a) If the treating chiropractic physician is an employee or associate, the duty to maintain original records shall be with the chiropractic business entity or chiropractic physician that employs or contracts with the treating chiropractic physician.
(b) Chiropractic physicians shall be responsible for keeping an available copy of all authored reports for seven years from the date authored.
(4) If a chiropractic physician releases original radiographic films to a patient or another party, upon the patient’s written request, he/she should create an expectation that the films will be returned, and a notation shall be made in the patient’s file or in an office log where the films are located (either permanently or temporarily). If a chiropractic physician has radiographic films stored outside his/her clinic, a notation shall be made in the patient’s file or in an office log where the films are located and chiropractic physician must ensure those films are available for release if requested by the patient.
(5) The responsibility for maintaining original patient records may be transferred to another chiropractic business entity or to another chiropractic physician as part of a business ownership transfer transaction.
(6) A chiropractic physician shall establish a plan for custodianship of these records in the event they are incapacitated, deceased or otherwise unable to maintain these records pursuant to paragraph (7).
(7) Except as provided for in paragraph (7)(e) of this rule, a chiropractic physician who is an independent contractor or who has an ownership interest in a chiropractic practice shall provide notice when leaving, selling, or retiring from the chiropractic office where the chiropractic physician has provided chiropractic services.
(a) Notification shall be sent to all patients who received services from the chiropractic physician during the two years immediately preceding the chiropractic physician’s last date for seeing patients. This notification shall be sent no later than thirty days prior to the last date the chiropractic physician will see patients.
(b) The notice shall include all of the following:
(A) A statement that the chiropractic physician will no longer be providing chiropractic services at the practice;
(B) The date on which the chiropractic physician will cease to provide services;
(C) Contact information that enables the patient to obtain the patient’s records.
(c) The notice shall be sent in one of the following ways:
(A) A letter sent through the US Postal Service to the last known address of the patient with the date of the mailing of the letter documented, or
(B) A secure electronic message.
(d) In the event of an illness, unforeseen emergency, incarceration, or other unanticipated incident, a chiropractic physician is unable to provide a thirty day notice as required by paragraph (7)(a) of this rule the chiropractic physician shall provide such notice within thirty days after it is determined that the physician will not be returning to practice.
(e) Paragraph (7) of this rule does not apply to the chiropractic physician who is departing as an employee of another Oregon licensed chiropractic physician. It is the licensed Oregon chiropractic physician employer’s responsibility to maintain continuity of care, or to comply with this rule if patient care will be terminated upon a chiropractic physician employee’s leaving employment or retiring.
(f) In the event a chiropractic physician dies or becomes incapacitated and unable to practice, and there is no other chiropractic physician associated with the practice, the deceased, incapacitated, or unavailable chiropractic physician’s executor, guardian, administrator, conservator, next of kin, or other legal representative shall notify the board in writing of the management arrangement for the custody and transfer of patient files and records. This individual shall ensure the security of, and access to, patient files and records by the patient or other authorized party, and must report plans or arrangements for permanent custody of patient files and records to the Board in writing within 180 days. Transfer of patient files and records must occur within one year of the death of the chiropractic physician.
Stat. Auth.: ORS 684
Stats. Implemented: ORS 684.155
Hist.: 2CE 1-1978, f. 6-16-78, ef. 7-1-78; CE 5-1995, f. & cert. ef. 12-6-95; CE 4-1997, f. & cert. ef. 11-3-97; BCE 3-2000, cert. ef. 8-23-00; BCE 2-2006, f. & cert. ef. 2-9-06; BCE 5-2013, f. & cert. ef. 11-27-13; BCE 3-2014, .f & cert. ef. 8-7-14; BCE 6-2014, f. & cert. ef. 9-5-14; BCE 2-2015, f. & cert. ef. 4-10-15
Disclosure Of Records
(1) A Chiropractic physician shall make available within a reasonable time to a patient or a third party upon the patient's written request, copies or summaries of medical records and originals or copies of the patient's X-rays.
(a) The medical records do not necessarily include the personal office notes of the Chiropractic physician or personal communications between a referring and consulting physician relating to the patient.
(b) The Chiropractic physician shall preserve a patient's medical records from disclosure and will release them only on a patient's written consent stating to whom the records are being released or as required by State or Federal law.
(2) The Chiropractic physician may establish a reasonable charge to the patient for the costs incurred in providing the patient with copies of any portion of the medical records. A patient shall not be denied summaries or copies of his/her medical records or X-rays because of inability to pay or financial indebtedness to the Chiropractic physician.
(3) Whenever the OBCE asks a Chiropractic physician for a response to a complaint or an investigation:
(a) The Chiropractic physician shall make available to the OBCE all requested patient file information, such as, but not limited to chart notes, billing records, x-rays, correspondence, reports and any and all relevant information.
(b) The requested patient file information shall be made available within 14 days of receipt of the OBCE's request unless the OBCE or the OBCE's representative determines by memo to the OBCE's investigative file that immediate availability of the requested records is necessary for the OBCE's investigation. Additional response time may be granted by the OBCE or it's representative upon a reasonable request.
(c) The Chiropractic physician must certify that all the requested records have been provided unless clear and compelling reasons are presented for failure to do so. Any documents not provided within the specified time must be identified along with the reasons. Failure to provide records to the OBCE within the time period specified by this rule for the purpose of responding to a complaint or an investigation is a violation of OAR 811-035-0015(19).
Stat. Auth.: ORS 684 , 791
Stats. Implemented: ORS 684.155 , 791 (SB 235)
Hist.: 2CE 2-1984, f. 8-14-84, ef. 9-1-84; CE 2-1987, f. 8-14-87, ef. 9-1-87; CE 1-1995, f. & cert. ef. 10-30-95 BCE 1-2001, f. 1-31-01, cert. ef. 2-1-01
(1) Clinical rationale, within accepted standards and understood by a group of peers, must be shown for all opinions, diagnostic and therapeutic procedures.
(2) Accepted standards mean skills and treatment which are recognized as being reasonable, prudent and acceptable under similar conditions and circumstances.
(3) All initial examinations and subsequent re-examinations performed by a chiropractor to determine the need for chiropractic treatment of neuro-musculoskeletal conditions shall include a functional chiropractic analysis. Some combination of the following PARTS exam constitutes a functional chiropractic analysis:
P Location, quality, and intensity of pain or tenderness produced by palpation and pressure over specific structures and soft tissues;
A Asymmetry of sectional or segmental components identified by static palpation;
R The decrease or loss of specific movements (active, passive, and accessory);
T Tone, texture, and temperature change in specific soft tissues identified through palpation;
S Use of special tests or procedures.
(4) Chiropractic physicians shall treat their patients as often as necessary to insure favorable progress. Evidence based outcomes management shall determine whether the frequency and duration of curative chiropractic treatment is, has been, or continues to be necessary. Outcomes management shall include both subjective or patient-driven information as well as objective provider-driven information. In addition, treatment of neuro-musculoskeletal conditions outside of the Oregon Practices and Utilization Guidelines -- NMS Volume I, Chapter 5, may be considered contrary to accepted standards. Chiropractic physicians treating outside of the Practices and Utilization Guidelines -- NMS Volume I, Chapter 5, bear the burden of proof to show that the treatment, or lack thereof, is clinically justified.
(5) Copies of any independent examination report must be made available to the patient, the patient's attorney, the treating doctor and the attending physician at the time the report is made available to the initial requesting party.
Stat. Auth.: ORS 684
Stats Implemented: ORS 684.155
Hist.: 2CE 1-1978, f. 6-16-78, ef. 7-1-78; CE 1-1995, f. & cert. ef. 10-30-95; BCE 2-2003, f. & cert. ef. 12-11-03; BCE 1-2005, f. 1-28-04, cert. ef. 2-1-05; BCE 1-2007, f. & cert. ef. 11-30-07
Continuing Chiropractic Education
(1) The purpose of continuing chiropractic education (CE) licensure credit is to assist in assuring the competence and skills of Oregon Chiropractic physicians, and to help assure the Oregon public of the continued competence of these physicians within the statutory scope of practice.
(2) In order to renew an active license, each licensee shall submit a signed affidavit on a form provided by the OBCE attesting to successful completion of 20 or more hours of chiropractic continuing education course or activity hours completed during the preceding licensure period. Each licensee shall maintain records as required in section (10) to support the hours reported in the signed affidavit.
(3) Courses or activities determined by licensees to meet the criteria of sections (8) and (9) are presumed to be approved until or unless specifically disapproved by the OBCE. Licensees will be informed of any disapproved courses in a timely manner. The Board will not retroactively disapprove course credits. The Board will maintain a list of disapproved courses available for review by licensees.
(4) The Board may require specific courses as part of a chiropractic physician’s annual relicensure hours for an upcoming licensure period.
(5) Any Chiropractic physician who is also licensed as a naturopath, osteopath, medical doctor, nurse or nurse practitioner is exempt from the over-the-counter non-prescriptive substances requirements of sections (6) and (7).
(6) Any Chiropractic physician holding an initial license is exempt from continuing education for the first year of licensure, except for four (4) hours relating to over-the-counter non-prescriptive substances and any specific courses required by the Board.
(7) Anyone changing license status from inactive to active or senior active license shall take four (4) hours of the required hours relating to over-the-counter non-prescriptive substances prior to changing license status and any specific courses required by the Board.
(8) Approved continuing chiropractic education shall be obtained from courses or activities which meet the following criteria:
(a) They do not misrepresent or mislead;
(b) They are presented by a Chiropractic physician, licensed here or in another state, other appropriate health care provider, or other qualified person;
(c) They exclude practice-building subjects and the principle purpose of the program may not be to sell or promote a commercial product. However the mere mention of practice building concepts shall not disqualify a program’s eligibility for CE credit.
(d) The material covered shall pertain to the practice of chiropractic in Oregon or be related to the doctor’s practice;
(e) Continuing education hours for Board activities must assist in assuring the competence and skills of the chiropractic physician; and
(f) Shall be quality courses or activities adequately supported by evidence or rationale as determined by the Board.
(9) The Board may accept credit hours from courses, seminars or other activities. Completion of other activities is chiropractic continuing education defined as follows:
(a) Continuing Medical Education(CME);
(b) Video or audio taped Continuing Education courses or seminars;
(c) Long distance learning courses;
(d) Being an original author of an article, published in a peer reviewed journal, given in the year of publication;
(e) Participation in a formal protocol writing process associated with an accredited health care institution or state or government health care agency;
(f) Participation on an OBCE committee and assisting with a National Board of Chiropractic Examiners (NBCE) examination or NBCE test writing committee;
(g) Participation in a research project, approved by the Board, related to chiropractic health care directed by an educational institution or other qualified chiropractic organization;
(h) Teaching courses at an accredited health care institution;
(i) Teaching chiropractic continuing education courses;
(j) CPR courses; and
(k) Instruction related to OAR 811-015-0030, minor surgery/proctology rotation;
(l) And any other course or activity specifically authorized by the OBCE.
(10) All licensees are required to keep full, accurate and complete records:
(a) A verification of attendance for all CE courses or activities showing hours claimed for relicensure credit, and or proof of completion signed by the sponsor and licensee.
(b) Video taped or audio taped courses shall be supported through record keeping with a letter, memo or on a form provided by the Board, that includes the dates and times, vendor’s or presenter’s name/s, total hours claimed for each course, location, and includes the following statement, “I swear or affirm that I viewed or listened to these continuing education courses in their entirety on the dates and times specified in this report.”
(c) A copy of a published article including the date of publication;
(d) A written record of hours in clinical protocol development and research projects. The record shall include the names and addresses of the institutions involved, name of supervisors, and their signatures verifying hours.
(e) For licensees claiming CE hours under the provisions of (9)(h), a record of employment by health care institutions, signed by their supervisor, a copy of the course syllabus if applicable, and verification of hours.
(f) For licensees claiming CE hours under the provisions of (9) (i), licensee shall obtain and keep verification of the course taught including, the dates of the course, a syllabus and the sponsoring organization.
(g) For licensees claiming CE hours under the provisions of (9)(f), for participation on an OBCE committee and assisting with a National Board of Chiropractic Examiners; (NBCE) examination or NBCE test writing committee, certification from the OBCE or NBCE.
(h) For licensees claiming CE hours under the provisions of (9)(k), a record of the dates, topics/procedures, and hours.
(11) At each renewal the OBCE will generate a random computer list of a minimum of 10% or up to 100% of renewing licensees, who will then have their CE records reviewed to ensure compliance with this rule. Licensees shall respond to this request within 30 days by supplying the OBCE with verification of their CE courses or activities as provided in section 10.
(12) Any licensee who has submitted inadequate, insufficient, or deficient CE records or who otherwise appears to be in noncompliance with the requirements of this rule will be given written notice by the OBCE and will have 30 days from the date of notice to submit additional documentation, information or written explanation to the OBCE establishing the licensee’s compliance with this rule.
(13) At its discretion, the Board may audit by attendance the content of any program in order to verify the content thereof. Denial of an audit is grounds for disapproval.
(14) Any chiropractic physician seeking a hardship waiver from their continuing education requirements shall apply to the Board, in writing, as soon as possible after the hardship is identified and prior to the close of licensure for that year. Specific details of the hardship must be included. The Board must make a finding that a hardship exists.
(15) The Board shall maintain and make available through its WEB page and mailings to licensees a list of disapproved courses, if any. The Board may disapprove a course or CE activity after giving the sponsor and/or licensees the opportunity to provide additional information of compliance with the criteria contained in this rule, and opportunity for contested case hearing under the provisions of ORS 183.341 if requested. Any CE sponsor or licensee may request the Board to review any previously disapproved course at any time.
Stat. Auth.: ORS 684.155
Stats. Implemented: ORS 684.092
Hist.: 2CE 1-1978, f. 6-16-78, ef. 7-1-78; 2CE 1-1984, f. 7-16-84, ef. 8-1-84; 2CE 5-1985, f. 11-13-85, ef. 12-1-85; CE 1-1996, f. & cert. ef. 2-28-96; CE 4-1996(Temp), f. & cert. ef. 9-27-96; CE 1-1997, f. & cert. ef. 3-4-97; CE 4-1997, f. & cert. ef. 11-3-97; BCE 3-2000, cert. ef. 8-23-00; BCE 1-2002, f. & cert. ef. 2-6-02; BCE 1-2007, f. & cert. ef. 11-30-07; BCE 3-2008, f. & cert. ef. 12-23-08
Chiropractic Obstetrics, Minor Surgery, and Proctology
(1) A Minor Surgery/ Proctology Review Committee will be appointed by the Board of Examiners. Members will serve at the pleasure of the Board. The committee may review the applications and rotation plans. The committee will review the results of the rotation and make a recommendation to the Board regarding the certification. The committee may advise the Board on all issues related to minor surgery and proctology.
(2) A chiropractic physician licensed in Oregon who wishes to practice minor surgery and/or proctology must apply to, and receive from, the Board a certification of special competency in minor surgery and/or proctology. To receive and maintain certification, the applicant must fulfill the following requirements:
(a) Give written application to the Board of Chiropractic Examiners to practice minor surgery and/or proctology, provide evidence of completion of 36 hours of undergraduate or postgraduate coursework in minor surgery/proctology, and propose a plan to complete a rotation for practical experience in not less than 25 minor surgery/proctology cases. The purpose of the rotation is to learn and demonstrate competencies, as determined by the Minor Surgery/Proctology Review Committee, under the guidance of one or more supervising licensed physicians. The numbers of procedures required in each of these areas will be determined by this committee.
(A) The rotation must include no less than five cases where all aspects of the cases are performed solely by the chiropractic physician, and observed by the supervising licensed physician.
(B) The remainder of the rotation not covered in paragraph (A) shall consist of cases where the chiropractic physician observes and/or assists.
(C) Adequate documentation of the Chiropractic physician’s participation in all cases is required on forms provided by the Board, and signed by the supervising licensed physician. It is recommended the rotation be completed within one year.
(b) 12 hours of continuing education (seminar, course or instruction) related to minor surgery/proctology every three years. Optionally, in lieu of eight hours of the continuing education requirement, a chiropractic physician may document performance or observation of twelve minor surgery/proctology procedures every three years. Reasonable documentation of the procedure or observation is a copy of the patient schedule and/or patient billing/ or other patient record with the patient name redacted which indicates the type of procedure and date performed.
(3) A chiropractic physician who is also licensed in Oregon as a doctor of naturopathy may make written application to practice minor surgery and proctology. The application may be approved by the Board if the chiropractic physician can demonstrate his naturopathic training and experience is equivalent to that required under section (2).
(4) A chiropractic physician licensed in Oregon who wishes to practice natural childbirth must apply to and receive from the Board a certification of special competency in natural childbirth. To receive and maintain certification, the applicant must fulfill the following requirements:
(a) Successfully complete at least 200 hours of direct instruction hours at an approved chiropractic, naturopathic, medical, osteopathic college or hospital in obstetrics and furnish a signed log showing evidence that subsections (b) and (c) of this section have been completed under the direct supervision of a licensed practitioner with specialty training in obstetrics and/or natural childbirth;
(b) Take part in the care of 50 women in both the prenatal (including obstetrics intakes) and postnatal periods;
(c) Observe and assist in the intrapartum care and delivery of 50 natural childbirths in a hospital or alternative birth setting. These births must be under the supervision of a licensed practitioner with specialty training in obstetrics and/or natural childbirth. A labor and delivery that starts under the care of someone licensed to assist in childbirth and includes hospitalization shall count as a birth.
(d) Pass a certification exam in obstetrics given by or approved by the Board.
(e) Submit annually, at the time certificate holders submit their general continuing education hours, 15 hours of Board approved continuing education in obstetrics. Seven of the 15 hours in obstetrics may be used to satisfy OAR 811-015-0025(4). Every other year an approved class in neonatal resuscitation shall be part of this continuing education requirement.
(5) Licensing action by the Board under ORS 684 shall be deemed to have an equal effect upon a certificate of special competency issued the practitioner, unless specifically provided otherwise in the Board action.
(a) When the subject of a disciplinary proceeding relates specifically to the practice of minor surgery, proctology, or natural childbirth by a licensee who possesses a certificate of special competency, the license action may in lieu of affecting the entire scope of the licensee's practice, suspend, revoke, or curtail only the practitioner's authority under the certificate of special competency.
(b) To address emergency or other circumstances which indicate the use of substances or procedures not authorized for use by chiropractic physicians, a plan to access these must be developed in a timely fashion and entered in the patient’s chart.
(6) Notwithstanding section (4), a Chiropractic physician may obtain a license as a direct entry midwife from the Board of Direct Entry Midwifery. Any chiropractic physician licensed as a naturopathic physician and certified in natural childbirth by the Oregon Board of Naturopathic Examiners, may also practice natural childbirth/obstetrics as a chiropractic physician to the extent allowed by ORS 684.
Stat. Auth.: ORS 684
Stats. Implemented: ORS 684.155
Hist.: 2CE 1-1978, f. 6-16-78, ef. 7-1-78; 2CE 6-1985, f. 11-13-85, ef. 12-1-85; CE 2-1995, f. & cert. ef. 10-30-95; CE 3-1995, f. & cert. ef. 11-3-95; BCE 2-1998, f. & cert. ef. 5-29-98; BCE 3-2000, cert. ef. 8-23-00; BCE 1-2009, f. & cert. ef. 1-29-09
(1) A Chiropractic physician shall not use or participate in the use of improper advertising. Improper advertising is any advertising which:
(a) States any fact which would result in the communication being untruthful, misleading or deceptive;
(b) Contains statistical or other assertions of predicted rates of success of treatment; or
(c) Claims a specialty, degree or diplomate not possessed or that does not exist;
(2) A chiropractor shall not practice under a name that is misleading as to the identity of the chiropractor or chiropractors practicing under such name or under a firm name which is misleading.
(3) A Chiropractic physician shall adhere to the Doctors' Title Act, ORS 676.110(2).
(4) A Chiropractic physician may use a professional card and/or letterhead identifying the Chiropractic physician's name, profession, address, telephone number, name of the chiropractic office and educational degrees. It may also include names of licensed associates.
Stat. Auth.: ORS 684
Stats. Implemented: ORS 684.155
Hist.: 2CE 1-1983, f. 1-12-83, ef. 2-1-83; 2CE 7-1985, f. 11-13-85, ef. 12-1-85; 2CE 2-1986, f. 5-15-86, ef. 6-1-86; CE 1-1995, f. & cert. ef. 10-30-95; CE 2-1996(Temp), f. & cert. ef. 5-31-96; CE 3-1996, f. & cert. ef. 9-26-96; BCE 4-2001, f. & cert. ef. 11-23-01
Scope of Practice Regarding Examinations, Tests, Substances, Devices and Procedures
(1) The Board may examine any diagnostic and/or therapeutic examination, test, substance, device or procedure, herein after referred to as ETSDP, to determine its acceptability for patient care. The Board may require a Chiropractic physician to provide information on any ETSDP for determination of its status. The Board may take into account all relevant factors and practices, including but not limited to, the practices generally and currently followed and accepted by persons licensed to practice chiropractic in the state, the teachings at chiropractic schools accredited by the Council on Chiropractic Education or its successor at any time since 1974, relevant technical reports published in recognized journals and the desirability of reasonable experimentation in the furtherance of the chiropractic arts.
(2) A Chiropractic physician may use any diagnostic and/or therapeutic ETSDP which is considered standard. A standard diagnostic and/or therapeutic ETSDP is one in which one or more of the following criteria have been satisfied:
(a) Is taught or has been taught by a chiropractic school accredited by the Council on Chiropractic Education or its successor at any time since 1974, or health professions' courses taught by regionally accredited colleges with subject matter that is within the scope of chiropractic practice and has not been disapproved by the Board; or
(b) Has been approved by the Board through the petition process:
(A) The petition requires a formalized agreement of 10% or more of the Chiropractic physicians, holding an active chiropractic license in Oregon, attesting to the safety and efficacy of a particular ETSDP. The petition shall be submitted in writing to the Board by any party wishing to establish any ETSDP as standard. It is the responsibility of the petitioner to gather the required evidence and supporting statements. It is the sole responsibility and discretion of the Board to review the sufficiency of the evidence in the petition and to make a determination whether to concur and affirm the ETSDP as standard or to deny the petition. The Board may, but is not required to, hold a public hearing on any petition. The Board shall make its determination and reply to the petitioner within 180 days of receipt of the petition unless the Board and the petitioner mutually agree to extend the deadline;
(B) The petition shall specifically address the following issues:
(i) The kind of ETSDP that is the subject of the petition, i.e., whether it is an examination, a test, a substance, a device, a procedure, or a combination thereof;
(ii) A detailed description of the proposed ETSDP;
(iii) The clinical rationale for the ETSDP;
(iv) A method for determination of appropriate termination of care and/or consultation to other providers with special skills/knowledge for the welfare of the patient;
(v) Whether the proposed ETSDP is to be used by itself or used in addition to any other generally accepted or standard ETSDP;
(vi) A description of known or anticipated contraindications; risks, and benefits;
(vii) A description of any subpopulations for which greater risk or benefit is expected;
(viii) A description of any standard ETSDP for the equivalent condition together with its relative risks and benefits; and
(ix) An assessment of the expected consequences of withholding the proposed ETSDP.
(c) Is supported by adequate evidence of clinical efficacy as determined by the Board. In determining adequacy the Board may consider whether the ETSDP:
(A) Has clinical rationale;
(B) Has valid outcome assessment measures;
(C) Is supported in peer reviewed literature;
(D) Is consistent with generally recognized contraindications to chiropractic procedures; and
(E) The potential benefit outweighs the potential risk to the patient.
(3) A Chiropractic physician may use any diagnostic and/or therapeutic ETSDP that has not met the criteria of subsections (2)(a) or (b) or (c) of this rule as investigational. It must show potential merit for effectiveness and be of acceptable risk. Documentation requirements are based on potential risk to the patient. All investigational diagnostic ETSDP's must include or be accompanied by standard diagnostic procedures until full Board approval is attained under the criteria cited in subsections (2)(a) or (b) or (c) of this rule. Nothing in this section is intended to interfere with the right of any patient to refuse standard or investigational ETSDP's. In determining risk, the Board may use the following criteria:
(a) For minimal risk procedures, defined as those which when properly or improperly performed on the general population would have a slight chance of a slight injury and when properly performed on select populations have an extremely remote chance of serious injury:
(A) Informed consent is suggested but not required; and
(B) The Chiropractic physician is recommended, but not required, to participate in or conduct a formal investigation of the procedure.
(b) For low risk procedures, defined as those which when properly performed on the general population have a slight chance of mild injury, when improperly performed on the general public have a mild chance of mild to moderate injury, and when properly performed in select populations have a remote chance of serious injury:
(A) Informed consent is required; and
(B) The Chiropractic physician is recommended but not required to participate or conduct a formal investigation of the procedure.
(c) For moderate risk procedures, defined as those which when properly performed on the general public have a significant chance of mild injury and a mild chance of moderate injury, when improperly performed on the general population have a slight chance of severe injury, and when properly performed in select populations have a slight chance of serious injury.
(A) Written informed consent is required; and
(B) The Chiropractic physician is recommended but not required to participate or conduct a formal investigation of the procedure.
(d) For high risk procedures, those which when properly performed on the general population have a significant chance of moderate injury and a slight chance of serious injury, when improperly performed on the general population have a significant chance of serious injury, and when properly performed in select populations have a significant chance of serious injury;
(A) Written informed consent is required; and
(B) The Chiropractic physician is required to participate in or conduct a formal investigation of the procedure under the auspices of, or in conjunction with, any other health care professionals knowledgeable and competent in the care and treatment of potential serious injuries.
(e) Board approval is required of all moderate or high risk procedures.
(4) The Board shall maintain a list of ETSDPs which have been reviewed by the Board and have been determined to be unacceptable or approved as investigational.
(5) A Chiropractic physician may not use any diagnostic and/or therapeutic ETSDPs which have been determined by the Board to be unacceptable.
Stat. Auth.: ORS 684
Stats. Implemented: ORS 684.155
Hist.: CE 3-1987, f. 8-14-87, ef. 9-1-87; CE 6-1995, f. & cert. ef. 12-19-95
License Suspension and Probation
(1) Chiropractic physicians and Chiropractic Assistants who are placed on suspension may not provide chiropractic treatment or services to any patient and are not to be in the clinic during business hours.
(2) The suspended chiropractic physicians shall not, directly or indirectly, engage in any conduct or make any statement which is intended to mislead or is likely to have the effect of misleading any patient, member of the public, or other person as to the nature of and reason for the suspension. It shall be prohibited to portray themselves to patients in any way as potentially practicing. Suspended chiropractic physicians may not perform intake functions and greeting patients. Suspended chiropractors and assistants should not be visible to patients as that could induce the belief they are practicing.
(3) Suspended chiropractic physicians shall prominently post in their clinic a suspension notice provided by the Board in a place conspicuous and readable to the public. The suspension notice shall remain posted during the entire period of actual suspension. The Board may waive this for good cause.
(4) Chiropractic physicians and assistants are prohibited from misrepresenting the status of licensure to any patients.
(5) Chiropractic physicians will be prohibited from using any student interns during the period of suspension or probation.
(6) Suspended chiropractic physicians may not provide any therapies as a CA. They may not personally sell or provide supplements or other products to clinic patients or persons coming in to the clinic. They may not perform adjustments on family or friends while they are suspended as this is the practice of chiropractic. They may not take films or perform any diagnostic procedures.
(7) Suspended chiropractic physicians may not engage in marketing which leads clients, consumers or patients to believe they are a practicing chiropractic physician at the time they are suspended. They may not place new advertising which indicates in any way the suspended chiropractic physician is practicing chiropractic during the suspension period.
(8) The list of prohibitions in this rule is not all inclusive and if the Board determines that a chiropractor was practicing chiropractic during the term of suspension it may result in disciplinary action. Violations of this rule may result in further discipline pursuant to ORS 684.100.
(9) A limited exception includes providing expert testimony at hearing or deposition, information to legal counsel in regards to a patient’s case that is in legal process of resolution regarding care provided prior to the suspension. Suspended chiropractic physicians are not prohibited from performing such business functions such as billing and attending tasks not related to patient scheduling, care, treatment or evaluation; but, it must be done outside of regular business hours.
Stat. Auth.: ORS
183.684 & 684.100
Stats. Implemented: ORS 684.155(b)
Hist.: BCE 3-2012, f. & cert. ef. 11-28-12
State Archives • 800 Summer St. NE • Salem, OR 97310