Practice of Podiatric Medicine by Podiatric Medical Students

(1) A licensee may permit a podiatric medical student to practice podiatric medicine subject to the provisions of M.G.L. c. 112, § 16A and B. The licensee's supervision of the podiatric medical student's activities must include the following requirements: (a) The podiatric medical student must be identified to a patient as a podiatric medical student and each patient must be informed that the patient has a right to refuse examination or treatment by the podiatric medical student. (b) The licensee must assure that the podiatric medical student practices podiatric medicine in accordance with acceptable podiatric medical standards of care. (Mass. Register #1480, 10/14/22) (2) Only licensees and the other individuals mentioned in M.G.L. c. 94C may issue and sign for controlled substances when acting within the scope of their license. The purpose of the podiatric medical record is to provide information to aid the registered podiatrist in the treatment of the patient. The licensee’s medical record is not written for the purpose of third party payment review and should not be relied upon as a basis for a third party payor’s denial of payment or as a basis for a third party payor’s determinations regarding the medical necessity of services rendered. The record shall contain a record of significant treatment provided and findings made by the podiatrist. Should a third party payor require information regarding a patient’s podiatric past or present needs beyond what is found in the medical record, the licensee may provide a brief written summary regarding that patient within 45 days of receiving that request in writing from the third party payor provided that no third party payor request more than 12 summaries in any one calendar year. The licensee shall not be held responsible for the maintenance of any patient record(s) at a nursing home facility, hospital or any other location other than the licensee’s own office. (1) The Board shall set standards for the documentation of podiatric medical care and may make suggested documentation forms available to licensees. Documentation should be limited to that necessary for appropriate patient care in order to maximize the podiatrist’s opportunity to provide direct patient care. (2) A registered podiatrist shall determine the podiatric medical necessity of podiatric services. He or she shall follow guidelines established by the Board regarding the issue of medical necessity. The podiatric medical record shall not be the sole source of this determination but the podiatrist may also rely on other sources including, but not limited to, records of other professionals. (1) Independent Practice in Nursing Home. A podiatrist attending patients in a skilled nursing home facility acts independently and is not under the supervision or control of any person employed by or practicing nursing or medicine at the nursing home facility. A licensed podiatrist is not required to obtain the approval or authorization of another physician or any other person before providing podiatry services in a skilled nursing home except from the patient or the patient’s guardian who may request or refuse a podiatrist’s services at any time. The direction and performance of a patient’s podiatric care shall not fall within the purview of the nursing or medical staff at any level of the nursing home facility. Patient Evaluation. A patient evaluation and management service, with treatment plan, detailing the type of care as well as its frequency, should be prescribed exclusively by the attending podiatrist. This is particularly appropriate for patients who will be receiving palliative foot care on a regular basis. [Board Form PD 1102 is approved and recommended for this service.] A reevaluation should be performed and treatment plan prescribed by the attending podiatrist approximately every 12 months or however often it is deemed necessary by the attending podiatrist for patients who receive palliative care. Documentation of palliation (trimming of nail and calvi) as well as treatment for onychomycosis, onychogryphosis and onychauxia should be minimized so as to allow the podiatrist the maximum opportunity to provide direct patient care. [Board Form PD1101 is approved and recommended for these services.] (4) A patient who demonstrates any level of vascular insufficiency diagnosed by the attending podiatrist shall receive palliative foot care approximately every 60 days or however frequently the attending podiatrist deems that this service may be medically necessary. The podiatrist is the arbiter of podiatric medical necessity. (5) A patient evaluation should be performed and treatment plan prescribed by the attending podiatrist at least every 12 months or more often if necessary. [Board Form PD1102 is approved and recommended for this evaluation and management service.] (1) A registered podiatrist shall perform any and all patient examinations, including complete examinations, that are necessary for the effective identification and treatment of disorders, diseases, injuries or symptoms of the foot and ankle. Complete examinations, which are often necessary for the identification and assessment of systemic and localized conditions contributing to or causing disorders, diseases, injuries or symptoms of the foot and ankle, may encompass the evaluation of all organ systems or body parts. (2) A registered podiatrist shall order the performance of any test or study necessary to establish a proper diagnosis. The level and comprehensiveness of the examination performed shall be determined by the attending podiatrist. A licensee may perform surgery or treatment as set forth in M.G.L. c. 112, § 13 upon the human foot and ankle of a patient who is under anesthesia which is not local, provided that the anesthetic is administered by or under the direction of a qualified anesthesiologist. A licensee may employ nitrous-oxide-oxygen analgesia in the practice of podiatric medicine; provided however, that the quantity of nitrous-oxide-oxygen administered does not produce loss of consciousness of the patient. The Board shall determine standards of care for the delivery of podiatry as needed.