Scope Of Practice

(1) Any person who possesses a valid unsuspended and unrevoked license issued by the Board has the right to use the title licensed chiropractic physician. No other person shall assume this title on any work, letter, sign, figure, advertisement, or device to indicate that the person using the same is a licensed chiropractic physician. The work performed includes offering case management procedures and recommendations for health care and services to the public. (2) The scope of practice of a chiropractic physician shall be as set forth in T.C.A. § 63-4-101 and shall include: (a) As a portal of entry provider, a chiropractic physician has authority to make a differential diagnosis that may include the use of patient history, examination techniques, lab analysis and analytical instruments for the purpose of determining vital signs and screening of health status, orthopedic and neurological testing, range of motion and muscles testing and diagnostic evaluation and/or imaging of the human body that may be revealed in a state of pathology, as a basis for making clinical judgments as to the patient’s condition, degree or nature of treatment needed and management and rehabilitation of the human body which is in the opinion of the provider, appropriate for the support, restoration, and maintenance of health. GENERAL RULES GOVERNING CHIROPRACTIC EXAMINERS CHAPTER 0260-02 (b) A chiropractic physician has the authority to utilize physical agent modalities and perform an adjustment, manipulation, manual therapy, dry needling, rehabilitation, or treatments which may include therapeutic care interventions to the human frame and/or soft tissues. (c) The chiropractic physician’s responsibility for patient care, case management, and the protection of the patient includes the authority to make a proper referral to another health care provider for consultation or collaborative care, and also for treatments, therapeutic procedures, recommendations, recording and reporting to third-party payers, preparing narratives, giving of depositions and in-court testimony as an expert witness and determination of impairment ratings. (d) The scope of practice of a chiropractic physician includes such supportive care as nutritional evaluation, recommendation and supplementation, patient management in their mental and physical environment, and due regard for patients concerning diet, hygiene, sanitation and rehabilitation. (e) The scope of practice of a chiropractic physician includes the ordering of imaging as defined in T.C.A. § 63-4-101(a)(1)(A)(ii). (f) The scope of practice of a chiropractic physician includes the performance of x-rays and other non-invasive diagnostic procedures as defined in T.C.A. § 63-4- 101(a)(1)(A)(iii). (g) The scope of practice of a chiropractic physician includes the collection of blood, urine, saliva, and hair for analysis as defined in T.C.A. § 63-4-101(a)(1)(A)(iv) or ordering the analysis of blood, urine, or other bodily fluid, secretions, or excretions from a licensed or certified laboratory for the diagnosis and management of the patient. (h) The scope of practice includes the use of “telehealth” also known as “telemedicine” for the purpose of diagnosis, consultation, or treatment of a patient in another location where there may be no in-person exchange. As a telehealth provider, services provided through a telehealth encounter shall comply with applicable state and federal statutes, as well as with rules promulgated by the Board. Telehealth providers shall be held to the same standard of care as healthcare services providers providing the same healthcare service through in-person encounters. (i) The Board of Chiropractic Examiners does not recognize any one document, guideline, textbook, clinical trial or study as the exclusive endorsement for setting standards of practice. (3) Spinal Manipulation/Spinal Adjustment (a) Training must be performed in chiropractic institutions or institutions that specialize in spinal manipulative therapy. Spinal manipulation is a highly skilled maneuver that requires adequate training. Four hundred (400) hours of classroom instruction and eight hundred (800) hours of supervised clinical training are considered a minimum level of education to properly administer the techniques. (b) Spinal manipulation must be performed by hand or with the use of instruments such as Activator, Grostic, Pettibon, mechanical and/or electromechanical devices. (c) Manipulation moves the spinal segments beyond their normal range of motion for the restoration of neurological integrity, and/or correction of articular dysfunction, but without exceeding the limits of anatomical integrity. GENERAL RULES GOVERNING CHIROPRACTIC EXAMINERS CHAPTER 0260-02 (d) A differential diagnosis is necessary to properly establish the indications and contraindications before the administration of the spinal manipulation/adjustment procedure. (4) Acupuncture - A licensed chiropractic physician who practices acupuncture must complete two hundred and fifty (250) hours of an acupuncture course accredited by an agency or entity acceptable to the Board and pass the National Board of Chiropractic Examiners (NBCE) Acupuncture Exam. Prior to engaging in the practice of acupuncture, a chiropractic physician must: (a) Request that an official transcript be sent directly to the Board’s administrative office from an accredited acupuncture program demonstrating successful completion of at least 250 hours training and education; and (b) Request that official proof be sent directly to the Board’s administrative office from the NBCE demonstrating successful completion of the acupuncture exam. (c) Upon receipt, the Board office shall provide a letter to proceed with the practice of acupuncture. (5) Animal Chiropractic - The scope of practice for animal chiropractic is set forth in T.C.A. § 63- 4-101(a)(1). (a) A chiropractic physician may engage in the practice of animal chiropractic if certified to do so by the Board. In order to be certified by the Board to practice animal chiropractic, a chiropractic physician must: 1. Submit proof to the Board’s Administrative Office of obtaining a certificate of animal chiropractic from the American Veterinary Chiropractic Association (AVCA), or a similar curriculum approved by the Board consisting of at least 210 hours in animal chiropractic. 2. Upon receipt of the above information, the Board’s Administrative Office shall provide a letter confirming the chiropractic physician’s ability to proceed with the practice of animal chiropractic. The Board shall maintain on its website a list of chiropractic physicians who are certified in good standing to perform animal chiropractic. (b) A chiropractic physician who performs animal chiropractic in the same facility where human patients are treated shall maintain a separate, non-carpeted room for the purpose of treating animals. The table and equipment used for animals shall not be used for human patients. A chiropractic physician who treats both animal and human patients in the same facility must post a sign in the reception area of that facility informing patients that nonhuman patients are treated on the premises.