Myth Busters

All Myth vs Fact

• Physiotherapists are one of the approved professions who can provide letters for patients stating their need for a service animal.

  Fact

  Physiotherapists are one of the approved professions who can provide letters for patients stating their need for a service animal. 
  
  People who use service animals may require such a letter when interacting with employers, landlords, university campuses, businesses, and others. The stated need should fall within the scope of physiotherapy practice. If a person requires a service animal for reasons outside the scope of physiotherapy practice, they can request a letter from one of the other approved regulated health professions including:

  • Audiologists and Speech-Language Pathologists
  • Chiropractors
  • Nurses
  • Occupational Therapists
  • Optometrists
  • Physicians and Surgeons
  • Psychologists
  • Psychotherapists and Mental Health Therapists

  In Ontario, an animal can be defined as a service animal if one of the following applies:

  (a) The animal can be readily identified as one that is being used by the person for reasons relating to the person’s disability, as a result of visual indicators such as the vest or harness worn by the animal.

  (b) The person provides documentation from one of the approved regulated health professionals confirming that the person requires the animal for reasons relating to the disability. 

• Physiotherapists are NOT allowed to receive a commission or financial incentive for selling certain products in their clinic.

  Fact
  
  By accepting a commission or financial incentive for selling certain products you could influence your clinical decision-making or affect a patient's decision (perceived or real). Physiotherapists should avoid conflicts of interest, or the appearance of conflicts of interest, between their personal financial interests and the best interests of their patients.
  
  Review the Conflict of Interest Standard for more information.
  
  

• I need to maintain liability insurance while on maternity/paternity leave, even if I resigned my registration with the College

  Fact

  You are responsible for ensuring you have insurance coverage for claims that arise even after you have ceased patient care (long or short term leave, retiring) as claims may arise several months or years after the care was provided. Insurance companies may not automatically provide coverage for claims that arise after the policy has expired, even if the incident on which the claim is based occurred during the policy period.
  
  Some insurers may offer a discount while you are on leave - similar to tail insurance - give them a call to find out!

• A PT Can Prescribe Marijuana for Pain

  Myth
  
  No. Administering, prescribing or recommending medications is NOT within the scope of practice of PTs. If a patient asks about medical marijuana, refer them to an appropriate practitioner (e.g. a physician).
  
  Still have a question? Get in touch with one of our helpful Practice Advisors at advice@collegpt.org or call 1-800-583-5885 or 647-484-8800.
  

• Physiotherapists are not allowed to video record treatment sessions

  Myth

  You can video record a patient’s treatment session as long as you have the patient’s consent and you can store the video recording safely and confidentially. If you have any questions, please don't hesitate to contact the Practice Advisor at practiceadvice@collegept.org or 647-484-8800.

• My registration will automatically expire if I don’t renew

  Myth

  All Independent Practice Certificate holders have an expiry date of March 31, and a PT must decide to renew or resign their registration to avoid suspension. Log in to the PT Portal to renew prior to the expiry date. Without officially resigning we will assume the PT is still practicing and their license will be suspended for non-payment of fees. The suspension will stay on their record.
  
  Contact registration@collegept.org or 1-800-583-5885 ext. 222 if you need assistance.
  
  Learn More about Renewals
  

• I just opened my own physiotherapy clinic. I need to register my business with the College

  Myth

  The College does not regulate clinics but rather individual physiotherapists. You do not need to register your business with the College but you do need to update your employment information. Contact our registration team at registration@collegept.org or log into your PT profile in the PT Portal.
  
  PT Portal

• Patients can make an anonymous complaint as well as being able to make a complaint about a clinic

  Myth

  A formal complaint must include the name and contact information of the person filing the complaint, the patient’s name where relevant, as well as the name of the PT involved.

  The College only regulates the practice of individual physiotherapists and not the place where PT practices. In some cases, if the employer or owner of the clinic or business is a physiotherapist it might be appropriate to file a complaint naming that person.
  
  File a Complaint
  
  
  
  

• When a PT gets a complaint they will automatically lose their license and won’t be able to practice anymore

  Myth

  When a complaint is received at the College, staff from the Professional Conduct team will contact the PT. Within 14 days of receiving/confirming the complaint, the College will send the PT a copy of the complaint and a letter explaining the complaints process. The College will ask the PT to respond to the complaint within 30 days, including submitting any additional relevant information. This initial documentation, plus any other information obtained by the College will be given to the ICRC for their consideration prior to making a decision. Their decision may not be to take the PT's license away. ICRC may choose to do any of the following:

  • Take no further action.
  • Give the PT advice on how to improve.
  • Require the PT to take a course or learning activity.
  • Refer the PT to the Discipline Committee—only the most serious cases go to Discipline for a public hearing.

  Learn More about Complaints

   

• The College requires PTs to have CPR training

  Myth

  The College does not require Cardiopulmonary Resuscitation (CPR) training in order to be registered as a PT. However, CPR is a valuable, potentially life-saving technique and the knowledge of how to correctly perform it allows you to be prepared for emergency situations or adverse reactions.

  
  

• PTAs cannot perform acupuncture or remove acupuncture needles

  Fact

  Acupuncture is a controlled act that only rostered PTs can perform. The removal of needles is still considered part of the acupuncture treatment and therefore cannot and must not be performed by anyone other than the rostered physiotherapist during physiotherapy treatment.
  
  Learn more about rostering
  
  

• The College approves continuing education programs

  Myth

  The College does not endorse any continuing education programs. Physiotherapists are responsible to find appropriate training related to her or his area of practice.

  
  

• Physiotherapists are not allowed to treat family members

  Fact

  Unless it is an emergency, PTs cannot treat relatives or persons they have a close relationship with.
  
  Boundaries and Sexual Abuse Standard

• I must not introduce myself to patients using the title Doctor even if I have earned a doctorate degree

  Fact

  When providing patient care, physiotherapists cannot use the title “Dr.”
  
  Restricted Titles, Credentials and Specialty Designations

• Student names must be included on patient invoices

  Fact

  Anyone who provides patient treatment on your behalf (for example, students and PTAs) should be listed on patient invoices by name and job title.

• According to legislation, an individual ceases to be a patient of their health care provider as soon as they're discharged from care

  Myth

  Under the provisions in the Protecting Patients Act (Bill 87) and in relation to sexual abuse, an individual continues to be a patient of their health care provider for a minimum of one year after they stop receiving treatment. 
  
  Review the College's Boundaries and Sexual Abuse Standard for more information. 

• PTs are legally obligated to make self-reports to the College.

  Fact

  It is a legal requirement for physiotherapists in Ontario to make self-reports. 
  These reports make the College aware of situations where a physiotherapist may not be practicing safely and it allows the College to take any appropriate steps to protect the public.
  
  A physiotherapist must self-report to the College if she or he:

  • has been found guilty of any offence in any jurisdiction (this includes anywhere in Canada or elsewhere in the world)
  • has been charged with any offence in any jurisdiction (this includes anywhere in Canada or elsewhere in the world)
  • has a finding of professional negligence and/or malpractice
  • has a finding of professional misconduct, incompetence or incapacity or any similar finding, in relation to the practice of physiotherapy or any other profession in any jurisdiction
  • is the subject of a current investigation, inquiry or proceeding for professional misconduct, incompetence or incapacity or any similar investigation or proceeding in relation to the practice of physiotherapy any other profession in any jurisdiction. (Note: Information about College proceedings need not be reported.)

  Not making a self-report is a serious matter and can result in referral to the Discipline Committee. To make a self-report, please complete the Online Mandatory and Self-Reporting Form. 

• Failure to file a mandatory report is an offence, which may be punishable by a fine of up to $25,000 by the government.

  Fact

  Failure to file a mandatory report is an offence, which may be punishable by a fine of up to $25,000 by the government and constitutes professional misconduct.

  Not making a self-report is a serious matter and can result in referral to the Discipline Committee. To make a self-report, please complete the Online Mandatory and Self-Reporting Form.

  Complete the Form

• A physiotherapist is solely responsible for how their registration number is used for billing.

  Fact

  Physiotherapists are accountable for any fee, billing or account that uses their name and registration number. Physiotherapists must be able to demonstrate how they routinely review their fees billing and accounts.
  
  You must:

  • Periodically review the claim forms that a health care facility submits using your name and registration number and keep a written record of the review.
  • Be aware of the conditions, billing codes (e.g. for MVAs) and dollar amounts being billed for your professional services.
  • Not sign blank treatment plans/forms.
  • Discuss your professional obligations to monitor and understand the business’ billing practices, prior to signing a new contract. Confirm that your name and registration number should not be used for care or services you did not provide.

  Additionally:

  • Be selective about the jobs you accept. You might be exposed to inappropriate business practices by clinic owners who put up barriers to meeting your professional obligations.
  • Remember, if the job is offering a huge sum of money for minimal work, then it is likely too good to be true. 

  Be cautious and don’t be afraid to ask questions!

• A physiotherapist and a chiropractor can treat the same patient for the same condition.

  Fact

  Yes, two different health care providers can treat the same patient for the same condition provided there is no unnecessary duplication and the providers communicate with each other about the patient’s care to ensure their approaches are complementary.
  
  Collaborative Care Standard

• A physiotherapist must file a self-report to the College if they have a charge of driving while texting.

  Fact...

  Yes, you must report the charge. Regulated health professionals must report all charges and offences to their regulator – it's the law. However, not all charges will appear on the Public Register. 
  
  Learn more about Self-Reporting

• Physiotherapists need to roster separately for acupuncture and dry needling.

  Myth!

  For the purposes of rostering, acupuncture and dry needling are the same activity. If you want to do both activities you need to develop the skills and competencies for each but need only roster once.
  
  Learn More About Rostering

• Physiotherapists can only claim practice hours for hours spent treating patients.

  Myth!

  Practice hours may also include paid hours of work in roles using physiotherapy theory and knowledge. 
  
  Learn More About Practice Hours

• A Physiotherapy Resident is able to perform a controlled act such as acupuncture.

  Fact!

  A Physiotherapy Resident is able to perform a controlled act provided that they have the knowledge, skills and judgment, are rostered and have a Practice Supervisor that is rostered for the same controlled act.
  
  Controlled Acts and Restricted Activities Standard

• Physiotherapists can charge patients a fee to provide them with a copy of their health record.

  Fact

  As custodians of patients’ personal health information, health professionals are required to provide a copy within 30 days of the request. The fee should cover administrative costs but it should not be cost prohibitive to the patient.
  
  Note:
  Please review the Record Keeping Standard and visit the office of the Information and Privacy Commissioner of Ontario (IPC) website at www.ipc.on.ca for more information about access to personal health information. 
  
  Adapted from the IPC website:

  1. You may charge a fee not exceeding reasonable cost recovery for providing access to an individual’s record of personal health information. 
  2. Before charging a fee, the Personal Health Information Protection Act (PHIPA) requires you to first provide the individual with a fee estimate.
  3. There is currently no regulation that sets the fee amount for providing access to an individual’s records of personal health information.

  However, Health Order HO-009 (2010) interpreted reasonable cost recovery and found that a custodian may charge a fee of $30 for photocopying or printing the first 20 pages of a record and 25 cents per page for every additional page. This $30 fee includes additional activities, for example, locating and retrieving the record, reviewing the contents of the record for not more than 15 minutes and preparing a response letter to the individual.
  
  IPC Website

• Physiotherapists need to provide annual statistics to the Information and Privacy Commissioner of Ontario (IPC).

  Fact

  Physiotherapists who are health information custodians (HICs) must report statistics relating to health privacy breaches annually to the Information and Privacy Commissioner of Ontario. 
  
  Learn more about mandatory statistics reporting.

• Physiotherapists are not permitted to work at two clinics within 10 kilometres of each other.

  The College does not have any rules or restrictions on this. Contact a contract lawyer to learn more about non-competition agreements and expectations.

• Physiotherapists are allowed to offer package deals or bundled services.

  As long as patients are given the option to purchase services individually and to receive a refund for unused services. 
  
  Review the Fees, Billing and Accounts Standard for more information. 
  
  The Standard

• A patient has the right to record their interactions with the physiotherapist

  FACT

  Yes and there is a trend of patients recording their consultations with health care professionals. That trend is not going away. The patient often wants to recall what the physiotherapist instructed. Although the PT may be worried about risks such as social media shaming or litigation it is important for physiotherapists to understand how the recordings improve the patient experience and have shown to improve patient outcomes.
  
  It is recommended that a PT has open communication with patients about the need to maintain privacy of other patients especially in a public area. 
  
  Bottom line: stay professional 100% of the time when you are with patients. Understand that a patient often needs help to recall physiotherapy advice and the recording is helpful for them. 

• The College will mail you a tax receipt at the end of the year

  MYTH

  The College does not mail or email tax receipts (invoices) to physiotherapists.

  You can access your annual tax receipt at any time yourself using the PT Portal.
  
  Simply log in to your account to download or print your annual renewal tax receipt using the Invoice button on the left side of the page. 
  
  If you have any questions, please contact the Registration team at registration@collegept.org or 1-800-583-5885 ext. 222.

• Your registration number is unique to you

  FACT

  Your registration number is like your fingerprint as a PT and is a way for the College and other stakeholders like insurance companies to identify you. It’s important that you protect your registration number and use it appropriately when providing and billing for treatment. 
  
  Here are some steps you can take if you feel like your registration number has been misused. 

• Spouses are not exempt from the definition of patient sexual abuse

  FACT

  There is a zero-tolerance approach to the sexual abuse of patients and spouses are not exempt. If a physiotherapist treats their spouse they could be found guilty of sexual abuse and the College is required, by law, to take away their license. PTs are not permitted to date their patients – or treat their spouses.
  
  Boundaries and Sexual Abuse Standard

• Physiotherapists can provide virtual group classes for patients. 

  FACT

  Physiotherapists may provide care to patients in a virtual group session if it is clinically indicated and can be provided safely and effectively. In order to be considered physiotherapy, each patient must be assessed individually, with goals and an individualized plan of care addressing issues identified on assessment. 
  
  Patients should be reassessed as appropriate with treatment adjusted as needed. Invoices must be accurate and indicate that care was provided in a group setting. Physiotherapists should check with patients to ensure that their insurer will cover virtual group treatment. 
  
  If there will be any in-person contact between patients and/or care providers e.g. patients in a group at one site and PT providing care virtually, physiotherapists should consider infection risks and ensure that they are familiar with and following all COVID-19 guidelines set out by the Ministry of Health. 

• A physiotherapist may treat a patient who is already seeing another physiotherapist for the same condition.

  FACT

  Two physiotherapists may treat the same patient as long as there is no unnecessary duplication. The PTs must communicate with each other about the patient’s plan of care to ensure their approaches are complementary and do not conflict. 
  
  A physiotherapist must take reasonable steps to understand what other care the patient is receiving and ensure that the physiotherapy treatment is compatible with the care provided by others. 
  
  You can find more information in the Collaborative Care Standard. 

• There are some situations where a physiotherapist may supervise a PT Resident virtually.

  FACT

  There are times when it can be challenging to arrange for an on-site supervisor for a PT Resident. It may be appropriate to arrange for virtual supervision in some cases, but there are some things to consider first. 
  
  Physiotherapist supervisors are responsible for providing a proper level of supervision for a PT Resident. This means they need to be able to ensure that the PT Resident can provide care safely and competently to patients and that the resident is meeting all College standards. The PT Supervisor and PT Resident should consider any factors that may influence this. 
  
  For example:

  • What is the current level of competency of the PT Resident?
  • How complex is the work environment and the conditions of the patient population?
  • What are the responsibilities involved in the PT Resident's job?
  • Will the PT Resident be performing any controlled acts?

  Consider if and how you could provide an appropriate level of supervision without being onsite. Consider all the risks, and how they could be managed. Document your discussions and plan with the PT Resident prior to beginning your supervisory role, and keep notes along the way describing what you have done to provide supervision. Ultimately it comes down to patient safety. PT Supervisors and PT Residents are both accountable for ensuring patients receive safe and effective care.

• Public Health Inspectors or the College can request to see a written policy for infection prevention and control for any setting where the PT provides care.

  FACT

  Physiotherapists are required by both the College and Public Health Ontario to have a written policy for infection prevention and control that they can refer to for all practice settings.
  
  The policy may be developed by your employer or one that you have written if you run a practice or work for yourself. Infection prevention and control measures specific to your practice environment should be outlined in the policy and must meet the College standard and Public Health requirements.

  When developing a policy, an excellent place to start is with the Provincial Infectious Diseases Advisory Committee (PIDAC) document Routine Practice and Additional Precautions in All Health Care Settings. You can find a fact sheet summary of this document on the Public Health Ontario website.

   •  PTs who employ others in their practice must ensure that staff know the policy and can access, understand, and follow the policy.

   •  PTs who are employed by an organization must know where to find the policy, what it says, and how to follow it.

  For additional guidance around infection control measures in various practice settings during the pandemic, have a look at our COVID-19 resources page.

  You can find more infection control resources and information in the College's Infection Control and Equipment Maintenance Standard.

   

  Can't find the information you're looking for? Call our Practice Advice team at 1-800-583-5885 ext. 241.

• If a PT leaves a practice, they are not permitted to take patient contact information to tell them about their new clinic.

  FACT

  Patient contact information (including telephone numbers, email addresses, and mailing addresses) is protected under PHIPA legislation.
  
  Contact information is identified by privacy legislation as private information. When custodians collect patient private information, they are required to do so for an identified purpose and may only use information for the purposes identified.
  
  The custodian is likely the clinic owner and therefore would need to provide the PT permission and have identified notifications of staffing changes as a purpose for data collection. If the custodian has not provided the PT permission to contact the patient after leaving the practice they may not use patient contact information for this purpose.

  A “health information custodian” (“custodian”) is a person or organization who, has custody or control of personal health information. This includes health care organizations such as hospitals, as well as some individual physiotherapists (such as owners of a PT clinic).

  In contrast, an “agent” is a person who is authorized by a custodian to perform certain activities on its behalf regarding personal health information. Generally speaking, this includes PTs practicing in hospitals and in clinics. Custodians are ultimately responsible for personal health information, as well as the actions of their agents (employed PTs).

   

• Physiotherapists must accumulate a certain number of worked hours in order to meet the College’s practice hour requirement.

  FACT

  When physiotherapists register with the College, they must have a minimum of 1200 practice hours over the previous five years. This number is determined by the College every time a PT registers or renews their license, based on the practice hours reported to the College during annual renewal over the previous five years.

  The exception to this is for PTs who have completed the clinical component of the PCE less than five years prior. Once it has been 5 years since the clinical component of the PCE has been completed, PTs must have accumulated a minimum of 1200 practice hours.

  PTs who do not meet the practice hour requirement can still renew their registration with the College. If the College determines a PT does not meet the practice hour requirements, they will follow up with the PT after annual renewal to discuss potential next steps.
  
  Learn more about Practice Hours.

• Physiotherapists may not provide patients with a reward for referring family or friends to their clinic.

  FACT

  COVID has been challenging for many physiotherapists who run their own business, and it may be tempting to offer a small reward as a thanks to patients who refer new patients to the physiotherapist’s practice. However, the Conflict of Interest Standard states that physiotherapists must not give any benefit to another person, or receive any benefit from another person, for a patient referral. 
  
  This includes patients who refer family or friends. In this case, PTs can offer a sincere thank you.
  
  Review the Conflict of Interest Standard for more information. 

   

• A physiotherapist may be a Practice Supervisor for more than one physiotherapy resident.

  FACT

  Physiotherapists who meet the requirements and have been approved by the College may supervise up to three physiotherapy residents at a time. 

  Learn more about being a Practice Supervisor by visiting our Supervision Overview page. 

  Want to be a Practice Supervisor or have more questions? Contact the Registration team at:

  registration@collegept.org or 1-800-583-5885 ext. 222

• My patient has asked me to not include specific information related to their past medical history in their chart. I must respect their instructions and not include the information in the chart.

  FACT

  Under the Personal Health Information Protection Act (PHIPA) patients are able to withhold or withdraw their consent for the collection, use or disclosure of their personal health information. Patients may provide express instructions to not use or disclose personal health information. These are known as lock-box provisions.
  
  Health Information Custodians (HICs) are required to respect the decisions of patients regarding how their health information is collected, used and disclosed. 
  
  More About Privacy

   

• A physiotherapist can refuse care in certain circumstances.

  FACT

  There are times when it may be appropriate for a PT to refuse or discontinue care. Examples include situations where a patient's safety is compromised and cannot be managed, the patient will not benefit from PT care, the patient becomes abusive, and other situations where it is not possible to provide safe and effective care. 
  
  When a patient needs physiotherapy, a physiotherapist who wants to discontinue care must ensure that one or more of the following conditions are met:
  
   •  the patient requests the discontinuation,
   •  alternative services have been arranged,
   •  the patient has been given a reasonable opportunity to arrange alternative services,
   •  the physiotherapist is unable to provide care that meets the standards of practice because there are not enough resources available,
   • the patient has failed to pay for physiotherapy services received within a reasonable time, and all reasonable attempts made by the physiotherapist to facilitate payment have been unsuccessful,
   •  the physiotherapist believes that the patient may become abusive,
   •  the patient has not cooperated or complied with the treatment plan and the result is  that the care is not effective, or
   •  a professional boundary has been breached and all reasonable steps have been taken to manage the behavior.
   
  The Providing or Refusing Care standard states that PTs may not refuse care based on discriminatory reasons, including the following:
  
   •  age    
   •  citizenship    
   •  disability
   •  ethnic origin     
   •  place of origin     
   •  creed    
   •  ancestry, colour, or race
   •  sexual orientation
   •  sex (including pregnancy and breastfeeding)
   •  gender identity, gender expression
   • marital status (including single status)
   • family status

  Review the Providing or Refusing Care Standard for more information. 

• PPE requirements for PTs are the same for working with both vaccinated and unvaccinated patients in a clinic setting.

  FACT

  Ministry of Health guidance for PPE is the same for working with both vaccinated and unvaccinated patients. Before every patient interaction, PTs must perform a point-of-care risk assessment to determine the level of precautions required. 

  For all interactions in a clinic setting with and within two metres of patients who screen negative on the COVID-19 Patient Screening Guidance document, PTs must wear a surgical or procedural mask. Eye protection (goggles or face shield) is required if a patient is unmasked. If the patient is masked for the entirety of the visit, eye protection may be used based on clinical discretion.

  For all interactions in a clinic setting with and within two metres of patients who screen positive, PTs must use droplet and contact precautions, including a surgical/procedural mask, isolation gown, gloves, and eye protection (goggles or face shield). 

  For all interactions in all settings with patients regardless of a positive or negative COVID-19 screen, PTs must perform hand hygiene before and after contact with the patient and the patient environment and after the removal of PPE.
  
  Helpful documents: 

  See the Ministry of Health document COVID-19 Guidance Primary Care Providers in a Community Setting.
  
  PPE requirements for home care, long term care and retirement homes, hospitals, and other settings are specific to each sector. Review the Ministry of Health guidance for required PPE in your work setting.

  When screening patients for COVID-19, PTs are required to use the most recent Ministry of Health COVID-19 Patient Screening Guidance document (version 5.0, updated August 26, 2021).

• The Advertising Standard applies to advertising done via social media.

  FACT

  An advertisement is any message in a public medium or in a public space promoting physiotherapy services and/or related products. This includes social media.

  Physiotherapists must review the advertisements placed by others on their behalf to ensure that they meet the expectations in the Advertising Standard. If they do not, physiotherapists must take reasonable steps to correct the advertisements and must document the steps taken.

  Physiotherapists must be able to prove that the information in the advertisement is true, does not mislead, is easy for consumers to understand and does not make claims of superiority.

  If an advertisement offers discounted prices for packaged or bundled services, it must clearly state that there is still the option to buy one service at a time. It must also make it clear that there is an option to receive a refund for unused services.

  Review the Advertising Standard for more information. 

• Practice Supervisors for PT Residents must be approved by the College and complete a Practice Supervision agreement before a PT Resident can practice.

  FACT

  PT Residents/applicants can propose the name of a Practice Supervisor in the PT Portal. Once the College has approved a Practice Supervisor, the supervisor will receive an email instructing them to log in to the PT Portal to complete a Practice Supervision Agreement. The College must receive the agreement before the Physiotherapy Resident can provide patient care.

  Practice Supervisors must be registered in Independent Practice in Ontario for at least three years.

  They cannot be related or closely associated with the Physiotherapy Resident (for example, a spouse, family member, or business partner).

  Physiotherapy Residents can have more than one Practice Supervisor, but Supervisors may not supervise more than three Physiotherapy Residents at one time.

  When the College considers a proposed Practice Supervisor, we take that person’s history with the College into account. For example, we will note whether the proposed Practice Supervisor:

   •  is the subject of an investigation

   •  is involved in remedial activities directed by the College

   •  has a history of practice concerns

  For more information regarding practice supervision, please review the information in the Supervision Overview section of our website.

• A physiotherapist must carefully balance the risks of assigning and supervising care with the patient’s best interests and quality of care.

  FACT

  A physiotherapist who assigns care to a physiotherapist assistant remains responsible for all of the patient’s care. The level of supervision required will vary depending on the patients’ needs and the level of risk associated with their condition or setting.  

  The knowledge, skill and ability of the PTA and the supports available in the treatment environment also factor into a decision about the level of supervision that is required. 
  
  Each physiotherapist must use his or her own professional judgment with respect to what level of supervision is required, keeping in mind that the PT needs to be able to intervene if necessary. The patient should always receive the same level of care that they would receive if the physiotherapist were providing the treatment directly.

  The physiotherapist must designate another physiotherapist that the physiotherapist assistant can contact if they cannot be reached. If this happens, a transfer of care takes place. The alternate supervisor assumes responsibility for decisions about the patient’s care and the care the physiotherapist assistant delivers.

  For more information about the rules physiotherapists must follow when assigning care to PTAs, see our Working with Physiotherapy Assistants Standard.
  
  You can also contact the Practice Advisors by email or phone with your questions.

• Getting consent from a patient is more than just having a patient sign their name to a form.

  FACT

  Before conducting an assessment or providing treatment, physiotherapists must get a patient’s permission to do so. This is known as consent.

  Informed consent requires a conversation with the patient. While a consent form may be helpful in guiding a discussion, physiotherapists are responsible for ensuring that patients understand what is going to happen before the treatment begins. PTs can do this by providing information about the nature of the treatment, its benefits, risks, side effects, the alternative courses of action, and any possible consequences of not having the treatment. The physiotherapist must also answer any questions the patient may have about the treatment. Conversations around consent should be documented. 

  Any activity that may pose a higher risk to the patient should involve a more careful and detailed discussion around consent. Consider risks around various types of activities such as controlled acts, care that will require the patient to reveal or be touched on a sensitive area of their body, care that may produce discomfort, etc. Ensure that there is time set aside for the consent conversation. 

  Remember that consent is an ongoing process, which means that physiotherapists should ensure that patients are agreeable to continuing care, to any changes in care, and understand that they can withdraw their consent at any time. 

  For more information about consent, see our Consent Resource and related FAQs, or complete our online Consent E-learning Module. You can also contact the Practice Advisors with your questions. 

• Physiotherapists must have a written process for routinely reviewing their fees, billings or accounts.

  FACT

  The College's Fees, Billing and Accounts Standard states that physiotherapists must ensure that any fee, billing or account that uses their name and registration number is an accurate reflection of the services and/or products provided.

  Physiotherapists must have a written process which must ensure that:
  

  • Any fees charged are accurate and reasonable
  • Billings or accounts are accurate

  Physiotherapists must be able to demonstrate that they did the review.

  If the physiotherapist discovers inaccuracies or errors, they must:

  • take reasonable steps to correct the inaccuracies or errors, and
  • document the finding, what action was taken, and the outcome.

  Looking for guidance? You can find an example of a written process on our website. Still not sure how this applies to your practice? Call the Practice Advisor!

• Physiotherapists need to ensure they have the patient's consent for any care that they provide, including ongoing care.

  FACT

  Before providing any care, a physiotherapist must have the patient's informed consent. This means that PTs should get consent before conducting an assessment or providing treatment, as well as any time the PT makes changes to the care they provide. Physiotherapists must also ensure that patients agree to continue with ongoing care, even if they have consented to the same care before. This is known as ongoing consent.
  

  Consent forms are recommended as a guideline for the conversation you have with the patient around consent. Consent can be given verbally, or in writing.
  

  Remember that patients can refuse to consent to treatment or withdraw their consent at any time. Having ongoing conversations and check-ins with patients around consent is a great way to ensure that patients feel comfortable proceeding with care, and helps to avoid misunderstandings - and complaints! This can include letting patients know that they can ask you to stop the assessment or treatment at any time if they feel uncomfortable, and that you are happy to answer any questions they have along the way. If you need to move a bra strap to better assess a shoulder, consider asking the patient if they themselves would be comfortable moving it to the side. If a patient is wearing pants that are too tight to allow for forward flexion of the spine, consider asking them if they could change into shorts, rather than pulling their pants down for them.
  

  When obtaining consent for care, PTs need to take time to provide all the information patients need to make a decision and answer any questions they may have. You will want to discuss the following and personalize to the patient's condition, needs and values:

   •  What you propose to do

   •  How they will benefit

   •  Any potential and material risks or side effects

   •  Any other viable options

   • The consequences of not receiving treatment 

   •  How often they will need to attend and the expected length of course of treatment

   •  The costs involved

   •  Answer any questions the patient may have
  

  Document in the patient's chart that consent was obtained. Use your professional judgment to determine what amount of detail to include, based on the situation. Consider including information such as: the information discussed, who was involved in the discussion, and the questions asked and answered. If you do have the patient sign a written consent form, be sure to include it in the patient's chart.
  

  For more information about getting informed consent, check out the following resources:

  Did You Get Consent? (video, 1 minute 17 seconds)

  Consent E-Learning Module

  Consent Resource (includes links to additional resources such as information about substitute decision makers, custody arrangements, and more)

• Physiotherapists need to retain the patient’s financial records.

  FACT

  Yes, the financial record must be retained for at least ten years from the date of the last entry in the patient's record. In the case of a minor, these records must be kept for at least ten years from the date the patient turns 18 years of age.

  The records may be kept separately from the clinical record. For example, the clinical record may be kept in paper format while the financial record is stored in electronic format. Keep in mind that the entire record should be retrievable for each patient during the entire retention period.

  It must contain:

   •  The name of the patient

   •  The name of the physiotherapist, physiotherapist assistant, and others who provided care under the physiotherapist's supervision 

   •  Date of service

   •  A description of the care, service, or product provided

   •  Amount of the fee for the care, service or product

   •  Any payment received

  Review the Record Keeping Standard for more information.

   

• An internationally trained physiotherapist can work as a PTA while awaiting credentialling.

  FACT

  Yes, it is okay to hire an internationally trained physiotherapist in the role of a physiotherapist assistant (PTA). A physiotherapist assistant provides care on behalf of, or as directed by, a physiotherapist.
  
  PTAs are not regulated in Ontario. The responsible physiotherapist must evaluate the physiotherapist assistant's competency and provide necessary training before assigning tasks. The PT must document what part of the care was assigned in the patient chart.
  
  Remember, the PT remains accountable and must supervise the care provided by the PTA.

  Review the Working with Physiotherapist Assistants Standard for more information.

• Physiotherapists cannot waive the co-payment for assessments and treatments provided to a patient.

  FACT

  Receipts should only be provided when money is actually received and should reflect exactly the service that was provided, and the exact amount collected. Anything else is fraudulent.
  
  Care should only be provided based on a patient’s need, not in anticipation of what the insurance company will pay for, and under no circumstance should PTs be helping patients defraud their insurance company!

  Fees, Billing and Accounts Standard

   

• A PT Resident must not use the title of “physiotherapist" on a patient’s invoice for ease of billing.

  FACT

  Anyone who provides patient treatment should be listed on patient invoices by name and job title. Whenever registrants use their title, they must use the title associated with their class of certificate of registration. Registrants with a Provisional Practice certificate must use the “physiotherapy resident” title. This includes variations and short forms such as “physical therapy resident,” “PT resident,” and equivalent terms in other languages.

  Physiotherapists must ensure that any fee, billing or account that uses their name and registration number is an accurate reflection of the services and/or products provided. Physiotherapists must never charge fees or create billings or accounts that are inaccurate, false or misleading.

  Fees, Billing and Accounts Standard

  Restricted Titles, Credentials and Specialty Designations Standard

   

• Physiotherapists are responsible for managing the boundaries within the therapeutic relationship with their patients.

  FACT

  Boundaries in patient care are physical and emotional limits of the therapeutic relationship between the patient and the physiotherapist. Physiotherapists must always act in the patient’s best interest.

  When managing the boundaries of the therapeutic relationship, the physiotherapist must:

  • Recognize that each patient’s boundaries will be unique to their own experiences, including their culture, age, values or experiences of trauma.
  • Be sensitive to the practice setting, especially when providing care in an informal environment, such as a patient’s home.

  • Respond appropriately when a professional boundary is breached. This involves identifying the breach, correcting the inappropriate behaviour, and documenting the actions taken to address the breach in the patient’s record.

  Boundaries and Sexual Abuse Standard

  How to Avoid Misunderstandings in a Clinical Setting (2-minute video!)

• Physiotherapists have a duty to report suspected child abuse, including physical, emotional and sexual abuse and/or neglect.

  FACT

  If you have reasonable grounds to suspect that a child is or may need protection, you must immediately report the suspicion and the information on which it is based directly to a children's aid society. If you think the matter is urgent and you cannot reach the children's aid society, call your local police. Everyone in Ontario, including members of the public and professionals who work closely with children, is required by law to report suspected child abuse or neglect. 

  The Reporting Child Abuse and Neglect: It's Your Duty brochure (PDF) explains the duty to report and answers common questions about your responsibility to report. It does not provide legal advice. 
  
  See the mandatory reporting obligations for physiotherapists for more information.

  There are different types of child abuse, as defined by the Ontario Association of Children’s Aid Societies: 

  Physical abuse is any deliberate physical force or action by a parent or caregiver which results, or could result, in injury to a child. It can include bruising, cuts, punching, slapping, beating, shaking, burning, biting or throwing a child. Using belts, sticks or other objects to punish a child can cause serious harm and is also considered abuse. 

  Neglect occurs when a caregiver fails to provide basic needs such as adequate food, sleep, safety, education, clothing or medical treatment. It also includes leaving a child alone or failing to provide adequate supervision. If the caregiver cannot give the child with basic needs due to financial inability, it is not considered neglect unless relief has been offered and refused. 

  Emotional abuse is a pattern of behaviour that attacks a child's emotional development and sense of self-worth. It includes excessive, aggressive or unreasonable demands that place expectations on a child beyond their capacity. Emotional abuse includes constantly criticizing, teasing, belittling, insulting, rejecting, ignoring or isolating the child. It may also include exposure to domestic violence. 

  Sexual abuse occurs when a child is used for the sexual gratification of an adult or an older child. The child may cooperate to please the adult or out of fear. It includes sexual intercourse, exposing a child's private areas, indecent phone calls, fondling for sexual purposes, watching a child undress for sexual pleasure, and allowing/forcing a child to look at or perform in pornographic pictures or videos or engage in prostitution. 
  
  

• Failure to maintain adequate charts according to the College’s standard is considered professional misconduct.

  FACT

  Clinical records are important communication tools that allow the physiotherapist and others to track the patient's past and current status, determine future care needs, give evidence of the care provided, collaborate when providing care, and transfer a patient’s care smoothly. Good record keeping enhances outcomes and safety for patients. The Physiotherapist is responsible for maintaining documents or records that are accurate, legible and complete and this is done in a timely manner. Failure to do so would be seen as an act of professional misconduct.
  
  The professional misconduct regulations under the Physiotherapy Act states the following are acts of professional misconduct in relation to Record Keeping:

  • Failing to keep records in accordance with the standards of practice of the profession.
  • Falsifying a record.
  • Signing or issuing a document containing a statement that the member knows or ought to know contains a false or misleading statement.
  • Signing or issuing a certificate, report, or similar document without taking reasonable measures to ascertain the accuracy of its contents.
  • Failing, without reasonable cause, to provide a report or certificate relating to an examination or treatment performed by the member within a reasonable time to the patient or his or her authorized representative after a patient or his or her authorized representative has requested such a report or certificate.

  It is important to reflect on your practice and ensure you are meeting the expectations of the Record Keeping standard. The College’s Record Keeping Checklist is a helpful resource to utilize during your reflections. 

• The College does not have set guidelines for the frequency of reassessments.

  FACT

  The College does not have specific guidelines for the required frequency of physiotherapy reassessments. Physiotherapists must use their clinical judgement to determine the appropriate frequency of reassessments for individual patients based on the patient's condition, treatment plan, progress toward goals, changes to their symptoms or health status, and other relevant factors.  
  
  If a patient needs to be reassessed after not attending physiotherapy treatment for a while, it’s important for the PT to have a discussion with the patient about the clinical reasoning for doing a reassessment and get the patient’s consent to proceed.  
  
  Physiotherapists must be able to provide clinical rationale for any service provided. 
  
  You can read more about what is expected of physiotherapists with regards to assessment, treatment, and reassessment on pages 9-10 of the Competency Profile for Physiotherapists in Canada.

• A patient can request a copy of their records.

  FACT

  A patient or their authorized representative can request a copy of their records.  
  
  Patients should understand how their personal health information will be collected, used, and disclosed and how they can access their health records. If a patient requests a copy of their records, it should be provided within a reasonable time frame. A fee may be charged to recover costs. 
  
  The Ontario Information and Privacy Commissioner has established guidelines for charging fees. According to these guidelines, it’s reasonable to charge $30.00 for processing a request and copying the first 20 pages. Twenty-five cents can be charged for every additional page.  
  
  Privacy

• Physiotherapists may teach family members or others to do exercises with a patient without ongoing supervision by the PT.

  FACT

  Physiotherapists can teach family members or others who are not under the direct supervision of a PT to assist patients with aspects of their care. A physiotherapist can use their professional judgement to determine if having the family member help with care would be in the patient's best interest. The PT should be confident that the family member can provide the care safely and effectively, and that ongoing supervision is not required.  

  The physiotherapist must obtain informed consent from the patient to have the family member perform the care, and ensure that the patient understands the risks/benefits involved and that the care is not being supervised by a PT. The patient and family member should know who to contact if they have questions or concerns. The PT should document any discussions and training given in the patient's chart. 

   

• When a person who has physiotherapist assistant (PTA) training has been assigned to assist a registered nurse (RN) in a Long-Term care facility, the staff physiotherapist remains responsible for the care assigned by the RN.

  MYTH

  No, the PT will not be responsible. A physiotherapist assistant (PTA) can only function as a PTA when they are assisting a physiotherapist. If someone who has PTA training has been assigned to assist another health professional like a nurse, then the assistant is acting under the assignment and supervision of that health professional. The physiotherapist is not responsible. Also, the PTA cannot carry out any physiotherapy related treatment while under the supervision of another health professional. This guidance applies to all employment locations and is not unique to LTC facilities.

  Working with PTA Standard

• Before working with a team of three physiotherapist assistants (PTAs), the physiotherapist must document patient consent and the names of each PTA involved in the patient’s care.

  FACT 

  Before working with a group of PTAs, the physiotherapist should have a conversation with the patient and obtain consent to include each of the PTAs in the patient’s care. The conversation should include the names of the PTAs who may be working with them, what treatment they will provide, and how to contact you as the physiotherapist if they have questions about their care.
  
  As outlined in the Working with PTA Standard and the Record Keeping Standard, there should be a record of all discussions a PT has with patients including obtaining ongoing consent, treatment and involvement of other care providers such as PTAs.

  As a reminder, PTs must ensure that the names and job titles of all physiotherapist assistants appear on invoices whenever they provide all or part of the treatment.