Prof Sem II (non SOAP note info)

allows one to decide the type of care they would like to receive if permanently unconscious or terminally ill (two physicians need to determine they will not recover)

living will

affects care that artificially postpones death, not those that ease pain

- need special instructions to remove feeding/fluid tubes

living wills

living wills take precedence over what?

Health Care Power of Attorney

designated person has authority to authorize and refuse medical treatment if one is unable to express their own wishes (even if only temporary)

health care power of attorney

the health care power of attorney cannot withdraw what?

comfort care, life-sustaining treatment, nutrition, and hydration (only if terminal or permanently unconscious)

- needs to be written by physician, clinical nurse specialist or certified NP

DNR law

no resuscitative measures but care to ease pain/suffering

DNR comfort care order

receives standard medical care including some components of resuscitation until has cardiac or respiratory arrest

DNR comfort care arrest order

what is the definition of physical therapy? what does it include?

the evaluation and treatment of a person by physical measures and the use of therapeutic exercises and rehabilitative procedures, with or without assistive devices, for the purpose of preventing, correcting, or alleviating physical impairments, functional limitations, and physical disabilities.

- includes physiotherapy

- NOT ON ANIMALS (in Ohio)

how often do PTs need to renew your license?

every 2 years (biennially)

what actions might cause you to lose your license?

- Conviction of a felony/crime

- Use of drugs

- License fraud

- Incompetency

- Violation of code of ethics

- Failure of Examination

- Posing as someone else

- Betrayal of a professional confidence

- Misdemeanor

- Sexual misconduct

- Failure to renew a license

- Failure to maintain supervision of a student

- Continuing an education requirement

- Failure to cooperate with an investigation

if a PT sees a patient without a referral, when are they required to contact the physician?

Inform physician no later than 5 business days after evaluation with patient consent. If no progress within 30 days after initial evaluation, PT must refer the patient to a physician. Unless treatment for fitness, wellness, prevention, or for previously diagnosed problems.

PTs can accept referrals from:

Medicine/surgery physician (MD), chiropractor, dentist, osteopathic medicine and surgery (DO), podiatric medicine and surgery, PA, nurse practitioner who are in good standing with licensing board

what are Ohio's continuing education requirements for licensure renewal (hours and activities)?

24 units in one or more courses, activities, or programs approved by the physical therapy section of the Ohio occupational therapy, physical therapy, and athletic trainers board. 1 unit is one clock hour in the state of Ohio (may differ in other states).

in Ohio, what exams are taken to obtain a license?

- a national physical therapy examination (NPTE) for physical therapists approved by the physical therapy section of the Ohio occupational therapy, physical therapy, and athletics trainers board. 4755.43

- a jurisprudence examination on Ohio’s laws and rules governing the practice of physical therapy that is approved by the physical therapy section 4755.43

what does supervision for a PTA mean?

- supervision: the availability and responsibility of the supervisor for direction of the actions of the person supervised (4755.40).

- a PTA may only be supervised by a PT and may not be supervised by any other person, including those persons licensed to practice in any other profession

***Do not have to be on-site but need to be readily available. Re-assign another supervisor if gone for extended periods

by Ohio law, what may not be delegated to a PTA?

The Physical Therapist performs the following, none of which may be delegated:

- Interpreting available information concerning the referral

- Providing the initial evaluation

- Developing the plan of care, including the PT goals

- Identifying and documenting precautions, special problems, contraindications, anticipated Progress, and plans for reevaluation

- Selecting and delegating only appropriate tasks in the plan of care

- Designating or establishing channels of written and oral communication

- Assessing the competence of the physical therapist assistant, other licensed personnel, and unlicensed personnel to perform assigned tasks

- Directing and supervising the PTA, other licensed personnel, and unlicensed personnel in delegated tasks

- Reevaluating and adjusting the plan of care, when necessary and performing the final evaluation, determining discharge, and establishing the follow-up plan

***No initial evals and assessments

what can be delegated to support personnel? can a PTA and a PT both delegate tasks?

Support personnel can:

Maintain and care for supplies

Prep and clean treatment areas

Transport patients

Office and clerical functions

Assist patients during treatment

Change clothes, assist with transfers, etc.

Personally assist PT, PTA, SPT, and SPTA during treatment

"Delegation in physical therapy is the sole responsibility of the physical therapist"

PT only, not PTA - PTA can ask support personnel for assistance

how do you function as a student? how are you to be supervised?

- only supervised by licensed PT that is on site and available

- SPT can perform patient evaluations, examinations, and interventions

as a student, how do you sign your notes?

sign your full name with SPT to acknowledge you are a student physical therapist along with date, and time. All notes must be cosigned by the supervising physical therapist. Dates and times added after review

unwelcome conduct of a sexual nature, which can include unwelcome sexual advances, requests for sexual favors, or other verbal, nonverbal, or physical conduct of sexual nature

sexual harassment

one form of sexual harassment. sexual _________ refers to physical sexual acts perpetuated against a person's will or where a person is incapable of giving effective consent. the creation of a hostile environment is another form of sexual harassment

sexual misconduct/violence

what year was title IX of the Educational Amendments Act established?

1972

- "this for that"

- "something for something"

- one is asked to provide sexual favors in exchange for something

quid pro quo

unwelcome behavior of a sexual nature that creates an offensive or disruptive environment

hostile environment

this is an example of what?

- standing behind someone seated at their computer and putting your hand on their shoulder

unwelcome behavior

this is an example of what?

- holding a handshake longer than usual

unwelcome behavior

this is an example of what?

- staring at someone's body when talking vs. eye contact

unwelcome behavior

behaviors creating a hostile environment (3):

- verbal

- nonverbal

- physical

type of behavior creating a hostile environment:

- sexual or gender based jokes

- repeated date requests

- grunts, whistles

- obscene emails

- terms of endearment

verbal

type of behavior creating a hostile environment:

- giving suggestive looks

- staring

- facial expressions

nonverbal/visual

type of behavior creating a hostile environment:

- invading personal space

- neck massage

- stalking

- inappropriate touching

physical

type of behavior creating a hostile environment:

- using email, social media, etc to send communications of a sexual nature

ex.

- inappropriate flirting or requests for dates

- inappropriate videos or pictures

- using sexually offensive language

- cyberstalking

online

this is an example of what?

- Jim the cafeteria manager tells the cashier Sara she'd better be nice to him if she wants a day off

quid pro quo

this is an example of what?

- after Cheryl refuses to date Russell, who works at the registrar's office, he refuses to release her transcripts she needs to get into a study abroad program

quid pro quo

this is an example of what?

- Mandy has a habit of leaning in close to Rachel and brushing her hand against her thighs when they are working at a shared work station. Rachel has asked her to stop but she continues to annoy her

hostile

this is an example of what?

- when a professor's secretary cuts off their office romance, he puts her on probationary warning for poor performance

quid pro quo

3 tests to determine if sexual harassment

1. creates intimidating, hostile environment or interferes with work or academics

2. submission to behavior is made a term or condition for employment or education

3. submission to or rejection of behavior is used as a basis for academic employment decisions

describes services provided

CPT code

evaluation codes are based on ______, not _____

complexity, not time

- based on complexity, not time

- low, moderate, high

- personal factors/comorbidities

- elements of body structure/function, activity limitations, participation restrictions

- clinical presentation

evaluation codes

0-7 minutes

0 units

8-22 minutes

1 unit

23-37 minutes

2 units

38-52 minutes

3 units

53-67 minutes

4 units

therapeutic exercises to develop strength and endurance, range of motion and flexibility; direct patient contact

therapeutic procedure

unable to charge for:

- phone calls

- writing letters

- documenting therapy session unless pt present

- set up and clean up

pt is seen for 55 minutes including 35 minutes of therapeutic activities and unattended electrical stim. what is the correct billing?

- 2 units of therapeutic activities

- 1 unit of e-stim

- reimbursement rates set by government

- for those over 65 y/o or SSI for those any age entitled to disability benefits for 24 consecutive months under SS/railroad retirement or are in end-stage renal disease

medicare

medicare part:

- inpatient hospitals, SNF, home health, hospice

A

medicare part:

- voluntary, outpatient and other medical expenses, some SNF

B

medicare part:

- prescription coverage

D

medicare part:

- Merit-based Incentive Payment System (MIPS) for private practice - value based program

B

centers for medicare and medicaid services (CMS) requires the plan of care to be reviewed and recertified by the physician at least every ______ or when the patient's _________

90 days, condition changes

- covers all ages

- income guidelines for coverage

- governed by federal guidelines, programs vary state to state

- managed care plans by providers

- alternative payment models

Medicaid

- members pay a premium, providers sign a contract w/ company

- HMO, PPO

- different rules and guidelines (reimbursement and documentation) for each company

insurance

- direct access

- benefits used

- high deductibles

- certain providers cash only

self pay

history includes:

- personal factors (age, coping skills, education, social background, etc.)

- comorbidities (other diagnoses)

required elements for all payers)

- subjective statements

- objective measures

- changes in status relative to each goal

- progress toward goals

- continuing treatment plans

- plan revisions

- changes in goals, updated plan of care, discharge plans sent to NP or Dr

progress report

the use of telecommunications and information technologies to share information, and provide clinical care, education, public health, and administrative services at a distance

Telehealth

APTA's position on Telehealth

- reduces cost, disparities, and shortages

- enhances PT practice, education and research

- needs to be accompanied with expansion of broadband access

benefits of Telehealth to patient:

- applies program in home setting

- increases family engagement

- decreases need for transportation - weather related issues

- increases safety

- improves accessibility

- saves time

- decreases in cost

T/F: I can treat a patient via telehealth in Ohio if the patient is just visiting their grandma in Florida

FALSE

Telehealth process

- ask for consent

- confirm patient's location

- documentation

- billing - copay