HAR §16-76-26. Minimal clinical competencies

The following addresses the minimal acceptable clinical competencies necessary to the practice of chiropractic. They identify the knowledge, skills, and attitudes required of the non-specialist, primary care doctor of chiropractic: (1) History taking or the element of patient evaluation in which relevant and appropriate information regarding the patient’s status is obtained; (2) Physical examination, an element of the evaluation in which information regarding the clinical status is elicited by selecting and using appropriate instruments and examination procedures; (3) Neuromusculoskeletal examination, the foundation of the chiropractic approach towards evaluating the patient’s health problems that are often associated with the spine and extremities. The spine and its relationship to nervous system function are also viewed as important factors in the patient’s general health. A neuromusculoskeletal examination involves the use of: (A) Inspection, palpation, percussion, range of motion, and appropriate procedures in a correct, orderly, safe and hygienic manner; and (B) Instruments and equipment in an appropriate, safe, and hygienic manner; (4) Psychosocial assessment, to recognize: (A) The interrelationships among the biological, psychological, and social factors which contribute to or affect patient behavior and well being and that affect the patient’s ability to report symptoms and comply with or respond to chiropractic care; (B) The clinical indications for referral to or collaborative care with appropriate mental health professionals, agencies, or programs; and (C) Circumstances that legally require the reporting of patient information to appropriate authorities; §16-76-26 76-13 (5) Diagnostic studies, which are those elements of patient evaluation in which objective data regarding the patient’s clinical status are elicited, and which include the use of diagnostic imaging, clinical laboratory, and specialized testing procedures. The doctor of chiropractic may: (A) Perform and interpret, order and interpret, or interpret appropriate imaging examinations; (B) Take, process, and interpret plain film radiographs; (C) Perform, order, and interpret clinical laboratory examinations; (D) Obtain and process laboratory samples; (E) Perform, order, and interpret other relevant procedures indicated by the clinical status of the patient; (F) Order or conduct diagnostic studies with attention to following professional protocol, and provide appropriate patient instructions and follow-up; and (G) Record data obtained from diagnostic studies whether personally conducted or ordered; (6) Case management which includes: (A) Developing and recording a patient care plan, case follow-up, the referral or referral and collaborative care necessary in the chiropractic management of a patient; (B) Appropriately and effectively communicating with the patient as to the health care needs and alternatives to chiropractic care that may be indicated; (C) Identifying and initiating appropriate drugless health care regimen; (D) Performing appropriate chiropractic adjustments, manipulations and mobilizations; (E) Referring the patient when clinically indicated, for consultation, continued study, and care; and (F) Establishing clear outcomes for care that can be used to evaluate clinical progress; responding to changes in patient status or failure of the patient to respond to care and recognizing when the patient has achieved resolution or maximum therapeutic benefit; (7) Adjustment, which is a precise procedure that uses one or more of the following techniques: (A) Impulse adjusting or the use of sudden, high velocity, short amplitude thrust of a nature that the patient cannot prevent §16-76-26 76-14 the motion, commencing where the motion encounters the elastic barrier of resistance and ends at the limit of anatomical integrity; (B) Instrument adjusting, utilizing instruments specifically designed to deliver sudden, high velocity, short amplitude thrust; (C) Light force adjusting, utilizing sustained joint traction or applied directional pressure, or both, which may be combined with motion to restore joint mobility; (D) Long distance lever adjusting, utilizing forces delivered at some distance from the dysfunctional site and aimed at transmission through connected structures to accomplish joint mobility; and (E) Controlled force, leverage, direction, amplitude, and velocity directed at specific articulations. Adjustive procedures are employed to influence joint and neurophysiologic function; (8) Manipulation of the articulations of the body; (9) Palpation of specific anatomical landmarks associated with spinal segments and other articulations; utilization of palpatory and other appropriate methods to identify subluxations of the spine and other articulations; (10) Adjustive, manipulative, and mobilization procedures which utilize appropriate positioning, alignment, contact, and execution that accommodate differences in patient body type and clinical status; and (11) Removal of subluxations of the articulations of the human spine and human frame and the adjacent tissues for the establishment of neural integrity, utilizing the inherent recuperative powers of the body for restoration and maintenance of health. [Eff and comp 9/22/01] (Auth: HRS §442-5) (Imp: HRS §442-1) SUBCHAPTER 5