Maryland’s Physical Therapy Act and Board regulations shape decisions made before, during and after patient care. A physical therapist evaluates and directs the plan of care; a physical therapist assistant implements authorized treatment under ongoing supervision. Students, aides and temporary license holders have different supervision rules. Those distinctions matter when a patient’s condition changes, a visit must be documented or a task is assigned. This guide follows the Maryland Jurisprudence Assessment Module’s subject areas through practical decisions, including licensure, continuing education, dry needling, telehealth and Board proceedings. Each example asks you to identify the person’s authority, the applicable duty and the action the facts support. The aim is to make the rules usable in a clinic, not merely recognizable by name.
Legislative Intent and Definitions
1. What counts as physical therapy
Maryland defines physical therapy through what the clinician does with findings, not simply the equipment used. A PT evaluates physical therapy needs, performs and interprets neuromuscular and musculoskeletal tests, plans treatment from those findings, and designs, implements, or modifies therapeutic interventions. Testing strength can supply objective data; deciding what weakness means for function is interpretation; selecting goals and interventions is planning. The same exercise may therefore have a different legal significance depending on whether someone is designing a rehabilitation program or carrying out an established plan. When classifying a task, ask who gathered the data, who interpreted it, and who decided the treatment direction. The Maryland physical therapy legal reference also identifies activities outside this practice definition, including taking X rays and using electricity for surgery.
Worked example: A PT measures ankle dorsiflexor strength as 3/5 on a documented manual muscle test, relates that finding to difficulty clearing the foot while walking, and plans progressive strengthening and gait training. The measurement supplies data; connecting it to walking and choosing treatment are interpretation and planning. All three steps belong in the PT’s evaluation and plan, with later response guiding any change.
Watch the distinction: A common error is to identify physical therapy only by an exercise or device. Evaluation, interpretation, and treatment planning are also parts of Maryland’s PT practice.
2. The limits of PTA practice
A Maryland PTA practices limited physical therapy under a licensed PT’s direction and ongoing supervision. Limited practice includes implementing therapeutic interventions and taking and documenting measurements. It excludes interpreting measurements and planning treatment programs. This distinction lets the PTA produce useful objective information without independently deciding its clinical meaning. The PTA should record the method and result, compare readily measurable values when useful, communicate a change to the supervising PT, and continue only treatment authorized within the PT’s plan and the PTA’s competence. The PT analyzes whether a change reflects recovery, measurement variation, or a new problem, then decides whether the plan needs revision. A PTA’s sound judgment during treatment includes recognizing an apparent safety concern and stopping the procedure, but that duty does not transfer the PT’s planning authority.
Worked example: A PTA measures knee flexion at 90 degrees on Monday and 105 degrees the next week using the same method. The recorded difference is 105 minus 90, or 15 degrees. The PTA documents both readings and reports the change. The PT decides whether that gain advances the patient’s functional goal and whether the treatment plan should change.
Watch the distinction: Because a PTA may take measurements, it is tempting to let the PTA interpret progress and revise goals. Maryland reserves interpretation and treatment planning to the PT.
3. Direct and ongoing supervision
Supervision terms describe different conditions, so match the rule to the person and task. Direct supervision requires a licensed PT to be physically present within the treatment area and immediately available to give aid, direction, and instruction while the procedure occurs. Ongoing supervision of a PTA requires continuing verbal and written contact sufficient to protect the patient’s safety and welfare. It does not, by itself, require the PT to remain in the treatment area. Maryland requires direct supervision for students, aides performing permitted treatments, and temporary license holders. A licensed PTA works under the PT’s direction with ongoing supervision, although particular circumstances may call for closer oversight to keep care safe. Classify presence separately from communication: a phone call can provide instruction, but cannot make an absent PT physically present.
Worked example: A PT at another clinic phones a licensed PTA, reviews the patient’s response, and gives instructions under an established plan. If that contact is adequate for safe care, it may contribute to ongoing supervision. The arrangement cannot satisfy direct supervision because the PT is outside the treatment area. A student or temporary license holder could not rely on that call alone.
Watch the distinction: Frequent calls do not become direct supervision merely because advice is immediate. Direct supervision depends on the PT’s physical presence in the treatment area.
4. Students and aides have different authority
Maryland treats a student’s educational practice and an aide’s work as separate exceptions to ordinary licensure. A student in a Board-approved physical therapy educational program may participate in practice under a licensed PT’s direct supervision. The educational setting and the PT’s presence matter; enrollment alone does not create independent practice authority. An unlicensed aide may perform only specified activities that do not require PT or PTA professional skills, subject to the aide rules and the required supervision for treatment. Aides may never perform an evaluation, even if a PT stands beside them. To assess an assignment, first identify the person’s status, then identify the exact task, and finally apply that role’s supervision rule. A title such as technician or rehabilitation technician does not expand an aide’s legal authority.
Worked example: A student enrolled in a Board-approved PT program evaluates shoulder motion while the supervising PT is present in the treatment area and immediately available. That fits the student exception. An aide working alongside the student cannot perform the same evaluation, even with the PT present. The aide’s supervision condition is necessary for permitted treatment, but cannot authorize a prohibited task.
Watch the distinction: It is easy to assume that direct supervision permits any learner or aide to evaluate. The student exception and the aide’s prohibited activities have different boundaries.
5. Boundaries of the Practice Act
The Maryland Physical Therapy Act preserves certain activities carried out under other authority. It does not limit someone who practices a health occupation that the person is authorized to practice, or a chiropractor authorized under the applicable chiropractic title. It also preserves nonmedical services associated with cosmetology or operating a health club. The key classification is the service actually provided, not the building’s name or the worker’s preferred title. General fitness instruction can remain nonmedical; evaluating a disability, interpreting rehabilitation findings, and designing treatment can enter regulated PT practice. The exception does not grant a health club employee a PT license or let a licensed worker exceed another occupation’s authority. When a scenario changes from broad wellness activity to individualized rehabilitation, reassess the work being performed rather than assuming the initial exception still covers it.
Worked example: A health club employee leads a general circuit class for members without assessing injuries or prescribing rehabilitation. That nonmedical activity falls within the Act’s health club boundary. A member then asks the employee to evaluate weakness after a neurological injury and design a treatment program. That new request involves PT evaluation and planning; the fitness-class exception does not authorize the employee to provide it.
Watch the distinction: A health club setting is not a blanket exemption. The exception concerns nonmedical services, so individualized evaluation and disability treatment require a separate authority analysis.
Board Powers and Duties
6. How the Board sets practice standards
Maryland’s legislature gives the Board authority to adopt regulations that implement the Physical Therapy Act, establish practice standards and a code of ethics, and regulate PT use of aides. This creates a practical reading sequence: identify the statutory authority, then apply the more detailed Board regulation to the specific assignment. A statute need not reproduce every operational rule before a regulation can govern practice within the Board’s authority. For instance, the Act recognizes the aide exception, while Board regulations specify permissible treatment activities, prohibited evaluation, direct supervision, and documented training. The Board’s code of ethics is a regulatory requirement for licensees, distinct from a professional association’s voluntary ethics materials. Where a task is at issue, use the rule governing that task rather than inferring permission from silence in a broad statutory definition.
Worked example: A clinic wants an aide to perform an unlisted treatment because the Act does not name that procedure. The Board’s aide regulation provides a specific permitted treatment list and prohibits other treatments. The clinic’s proposed assignment therefore fails even if a PT intends to supervise it directly. The controlling question is whether the task appears among the permitted aide activities.
Watch the distinction: Silence in the statute is not unlimited permission for aide work. The Board has express authority to regulate aide use, and its specific restrictions apply.
7. The Board’s investigative duties
The Board has both an investigative duty and a duty concerning evidence of alleged violations. It investigates alleged violations of the Maryland Physical Therapy Act, which means a report begins fact-finding rather than establishing guilt. The Board must present evidence of an alleged violation to the State’s Attorney for the county where the alleged violation occurred. This referral function is distinct from the Board’s licensing and disciplinary decisions: a prosecutor evaluates criminal action, while the Board handles matters within its regulatory authority. Keep the sequence clear in a scenario. Identify the conduct alleged, determine where it occurred, preserve the distinction between allegation and proven fact, and identify the appropriate recipient of evidence. A complainant need not prove a criminal case merely to bring information to the Board’s attention.
Worked example: A patient reports that an unlicensed person offers PT evaluations in a Maryland county. The Board investigates what services were offered, who offered them, and where. If the evidence indicates an alleged violation of the Act’s criminal provisions, the Board presents it to that county’s State’s Attorney. Investigation and referral do not themselves establish a conviction.
Watch the distinction: A Board investigation is not a criminal judgment. The Board examines allegations and refers evidence of an alleged violation; the State’s Attorney handles prosecution decisions.
Licensure and Examination
8. Qualifying before practice
Maryland generally requires Board authorization before someone practices physical therapy or limited physical therapy in the state. PT and PTA licenses confer different practice authority: a PT license covers physical therapy, while a PTA license covers limited physical therapy under a PT’s direction. Filing an application, paying a fee, finishing school, or passing an examination does not itself issue a license. A valid temporary license is a separate, limited authorization with direct supervision requirements. In any start-work scenario, check the person’s actual authorization and its effective status before considering what tasks the person may perform. Maryland may refuse a license to an applicant who begins PT or PTA practice before being licensed. The distinction also applies to offers to practice, so a candidate should avoid presenting availability as a licensed clinician before authorization exists.
Worked example: A graduate submits a complete PTA application and receives a payment confirmation but no license or temporary license. A clinic schedules the graduate to treat patients next week. The graduate has no Maryland authority to provide limited physical therapy yet, so the clinic must assign those treatments to an authorized practitioner or wait until the Board issues the appropriate authorization.
Watch the distinction: An application receipt shows that a process has started. It does not turn an applicant into a licensee or permit supervised patient treatment without separate authority.
9. PT education and clinical training
For a PT educated in a U.S. state, Maryland examines both the physical therapy program and completion of its clinical education. The program must have had the specified approval or accreditation in the year the applicant graduated; current program status alone does not answer that historical qualification. The applicant must also satisfactorily complete the clinical education required by that program. Application materials therefore need evidence of the curriculum and any required clinical training. Think of these as two linked but distinct conditions: the qualifying educational program establishes the academic route, and completed clinical education establishes that the route was finished. Neither replaces the other, and neither by itself completes the remaining licensing requirements, such as examinations and the criminal history review. The PT pathway applies to the full PT role, including evaluation and planning.
Worked example: A PT applicant earned a degree from a program accredited in the graduation year, but the program required a final clinical rotation that the applicant did not complete. The program criterion is met; the clinical education criterion is not. A diploma or application form cannot substitute for evidence that the required rotation was satisfactorily completed before the applicant qualifies through this pathway.
Watch the distinction: Graduation from a qualifying program and completion of required clinical education are separate facts. Do not assume a program’s accreditation proves that every required rotation was finished.
10. PTA education is a separate pathway
Maryland provides a distinct educational route for PTA licensure. A domestically educated applicant must graduate from a PTA program with the required approval or accreditation and satisfactorily complete that program’s clinical education. The applicant submits evidence of both with the PTA application. This route does not grant a PT license or the PT’s authority to evaluate, interpret measurements, and establish treatment plans. Once licensed, the PTA practices limited physical therapy under a licensed PT’s direction and adequate ongoing supervision. Keep three decisions separate: whether the education qualifies for a PTA application, whether the Board has actually issued PTA authority, and whether a proposed treatment is within limited physical therapy and the PT’s plan. A person can satisfy one decision without satisfying the others.
Worked example: An applicant graduates from a qualifying PTA program and completes its clinical rotations. Those facts support the education portion of a Maryland PTA application. They do not authorize work before licensing, and a later PTA license would not permit the applicant to perform a new patient evaluation independently. The licensed PTA could implement authorized treatment after the PT’s evaluation and plan.
Watch the distinction: A PTA credential is not a shorter route to PT evaluation authority. The two licenses have different education requirements and different scopes of practice.
11. Criminal history review
Maryland applicants undergo a State and national criminal history records check. The applicant submits the required fingerprint materials and fees through the Central Repository, which forwards the resulting information to both the Board and applicant. The Board cannot issue the license before receiving the required record information. A record is then assessed in context rather than treated as a single automatic conclusion: the Board considers the applicant’s age when the offense occurred, its circumstances, elapsed time, later work history, references, and evidence bearing on public safety. An applicant may contest the contents of the Central Repository statement through the statutory process. In reasoning through a case, separate completeness of the records check from the merits of the record. Disclosure and favorable references help the Board assess the facts, but cannot replace receipt of the required information.
Worked example: An applicant discloses a conviction from years earlier and supplies employment and character references. The Board has not yet received the State and national records information, so it cannot issue the license. Once the information arrives, the Board can weigh the offense’s circumstances, elapsed time, subsequent work, references, and evidence about risk to the public rather than deciding solely from the conviction label.
Watch the distinction: A disclosed conviction does not, by itself, resolve the licensing decision. Equally, an applicant’s personal disclosure cannot replace the required records check received by the Board.
12. National examination and Maryland law assessment
The national licensing examination and Maryland’s jurisprudence assessment test different requirements. The national examination addresses entry into the PT or PTA profession; the Maryland Jurisprudence Assessment Module addresses knowledge of Maryland practice law and rules. Passing one does not establish that the other has been met. The current Maryland JAM is an online, on-demand module with 35 questions and a 90-minute duration. Its issuer identifies the applicant groups that must pass it, including initial licensure applicants and those seeking an initial Maryland compact privilege. An out-of-state license or national examination score may support a separate licensing route, but the current JAM requirement must still be assessed for that route. Study the legal distinctions as practice decisions, not as substitutes for clinical examination content.
Worked example: A PT applicant has a qualifying national examination score and sends it to Maryland but has not passed the Maryland JAM. The national score addresses the national examination requirement only. The applicant still needs to meet the Maryland law assessment requirement for initial licensure, along with the other application conditions. The two results are separate pieces of the licensing decision.
Watch the distinction: Passing the national PT examination does not demonstrate knowledge of Maryland law. The current issuer applies the Maryland JAM requirement to initial licensure applicants.
13. Licensure through prior examination
Maryland may waive an examination requirement for an applicant already licensed or otherwise authorized in another state, but the waiver has conditions. The applicant must supply evidence of the other authorization, meet Maryland’s other qualifications, pay the application fee, and show a national examination score at least as high as Maryland requires. The application route calls for current license verification obtained directly from the licensing state and transmission of examination scores through the reporting service. A prior license is evidence, not an automatic Maryland license. Read the waiver alongside the current Maryland JAM policy: the issuer requires the JAM for applicants seeking licensure by endorsement. Thus, in a current application, prior national examination success may remove the need to repeat that examination while the Maryland law assessment and other requirements remain.
Worked example: An out-of-state PT submits verification of a current license and an official qualifying national examination score. Those materials may support waiver of the national examination under Maryland’s conditions. The PT must still complete the Maryland application, satisfy its remaining requirements, and pass the MD JAM for endorsement. Treating patients in Maryland cannot begin merely because the earlier state issued a license.
Watch the distinction: A license from another state does not transfer every requirement away. A qualifying prior national examination can support a waiver, while Maryland’s current JAM requirement remains for endorsement.
14. Foreign education and communication
A foreign-educated PT applicant must establish educational equivalence to the required U.S. physical therapy program through an approved credentialing agency. The evaluation must be forwarded directly to the Maryland Board, so a personal copy does not satisfy that transmission requirement. The applicant must also provide evidence of oral and written English competency under the applicable rules, unless an exemption applies, and attend an interview unless the Board waives it. Examination, score-transfer, and examination-waiver routes each have their own additional documents, but these foreign-education elements remain central. Reason through a file in layers: identify the foreign program, verify the approved agency and direct report, check the communication evidence, then examine the chosen licensing route and general conditions. A credential report evaluates education; it is not a license or a substitute for communication evidence.
Worked example: A foreign-educated PT emails the Board a personal copy of an equivalency report and a national examination score. The approved agency has not sent its report directly, and the applicant has supplied no required oral or written English competency evidence. The file remains incomplete despite the score. The applicant must provide the missing material through the specified channels before licensure can be decided.
Watch the distinction: Possessing an equivalency report is not the same as the Board receiving it directly from an approved agency. Educational equivalence also does not replace communication requirements.
15. Temporary license boundaries
A Maryland temporary license is a specific Board-issued authorization for an applicant who meets the relevant education and experience conditions except for a required examination. It permits the holder to practice the corresponding PT or limited PT role only under direct supervision. The supervising PT must be physically present in the treatment area and immediately available during practice. The temporary license ends at the first applicable event: 90 days after issuance, issuance of a full license, or Board revocation. The holder must also meet the stated jurisprudence and criminal history requirements. Check both the license’s current effectiveness and the required supervision at each encounter. A graduate’s eligibility to request a temporary license does not itself create one, and the temporary license cannot be extended simply by continuing to work while a full application is pending.
Worked example: The Board issues a temporary PT license on March 1. Its 90-day endpoint is May 30, assuming no full license or revocation occurs first. On May 10, the holder may practice only while a licensed PT is present in the treatment area and immediately available. If the Board issues a full license on April 15, the temporary license ends then, before May 30.
Watch the distinction: The 90-day period is a maximum endpoint, not a promise that the license always lasts that long. Full licensure or revocation can end it earlier.
16. Restricted licenses for teaching
Maryland’s restricted license serves a narrow teaching or study purpose for a PT licensed or registered in another state. The Board may issue it after the applicant meets the specified application and fee conditions and any other Board requirements. It permits physical therapy practice connected with giving a lecture or workshop, or taking a Board-approved short-term PT study course. Its duration is tied to that event: it expires when the lecture, workshop, or course ends, and the Board may not renew it. The holder may reapply for a new restricted license. To analyze a proposed activity, ask whether it is connected to the approved event and whether the event is still occurring. Ordinary clinic appointments after the workshop do not become authorized merely because the clinician held a restricted license that morning.
Worked example: An out-of-state PT receives a restricted license for a Maryland weekend workshop and demonstrates a treatment technique during the workshop. That activity is connected with the licensed event. On Monday, a clinic asks the PT to see two patients for routine care. The workshop has ended, so the restricted license has expired and cannot authorize those visits.
Watch the distinction: A restricted license is not a short general practice license. Its authority is tied to the specified teaching or study event and expires when that event ends.
17. Renewal before expiration
Maryland licenses are renewed on a biennial cycle, and each license expires on its Board-set date unless renewed. Renewal requires the application, fee, and satisfactory evidence of the applicable qualifications before expiration. A notice helps a licensee act on time, but the licensee remains responsible for renewal and for contacting the Board if a notice is not received. The legal practice question is whether the license is effective on the day services are provided, not whether a reminder arrived or an application is planned. Maryland expressly prohibits practice after expiration. Keep the dates distinct: the Board may state a deadline for receiving a renewal application so renewal can be issued before expiration, while the actual expiration date determines when the existing license stops authorizing practice.
Worked example: A PT’s license expires on May 31, and the PT receives no renewal notice. The PT works on June 1 without confirmation of renewal. The missed notice does not extend the license; June 1 practice occurs after expiration. The PT must stop licensed practice until the Board has issued effective authority, even if the renewal application was prepared earlier.
Watch the distinction: A missing reminder is not a grace period. Responsibility for keeping the license effective remains with the licensee, and practice after its expiration date is prohibited.
18. Reinstatement after expiration
Ordinary reinstatement of an expired Maryland PT or PTA license is available only within the statutory three-year window and only if all conditions are met. These include prior licensure by passing a Board-approved national examination, no Maryland PT or limited PT practice during the lapse, current entitlement to licensure, the required application and fee, and continuing education. An eligible applicant is not required to repeat the national licensing examination under that reinstatement route. If the person does not qualify for reinstatement, Maryland requires the current new-license requirements instead. Separate this expiration pathway from reinstatement after disciplinary suspension, revocation, or surrender, which is governed by Board orders and different rules. The expired license itself authorizes no care during the gap, even when the former licensee expects reinstatement.
Worked example: A PTA’s Maryland license expired two years ago. The PTA passed the approved national examination when first licensed, did not practice in Maryland during the lapse, and now submits the required application, fee, and continuing education evidence. Reinstatement may be available if the other conditions are met. Had the PTA treated Maryland patients during the lapse, this reinstatement route would fail.
Watch the distinction: Being within three years is only one condition. Maryland practice during the lapse, missing continuing education, or another unmet requirement can prevent ordinary reinstatement.
19. Continuing education for renewal
Maryland’s renewal continuing education is measured in CE hours, with one hour representing 60 minutes of learning activity rather than registration, breaks, meals, or social time. A PT ordinarily needs 30 CE hours for the renewal period; a PTA needs 20. The relevant learning must fall between June 1 and May 31 of the two-year period before renewal, and hours do not carry into the next period. Retain records showing the subject, completion evidence, hours, and date because the Board may request proof. A narrow first-renewal provision may allow renewal without CE when the original license was issued one year or less before renewal and the remaining requirements are met. For a routine calculation, first exclude out-of-window time, then exclude nonlearning time, then compare eligible hours with the role’s requirement.
Worked example: During the applicable June 1 through May 31 two-year window, a PT earns 28 eligible CE hours. The PT earns another 4 hours after May 31. Only 28 count for that renewal period; 30 minus 28 leaves a 2-hour shortfall. The later 4 hours cannot be shifted backward, and any excess from one period cannot be carried forward.
Watch the distinction: The total number of hours earned near renewal is not enough. Dates and eligible learning time determine which hours count, and Maryland disallows carryover.
20. Which learning activities earn credit
Before counting a learning activity, check its relevance to physical therapy practice, its professional audience, its learning objectives, and its approval status. The Board automatically approves qualifying offerings from APTA and FSBPT and accepts APTA-approved education; other activities may need Board approval or review. Credit then depends on the activity type. Attendance at an approved course may earn one CE hour per approved hour. Presenting continuing education may earn two CE hours per presentation hour, but the same subject earns presentation credit only once in a renewal period. These are credit rules, not permission to count every hour spent preparing, traveling, or networking. For the Maryland jurisprudence study guide, distinguish the subject you study from the separate question of whether a particular activity qualifies for renewal credit.
Worked example: A PTA completes 12 approved course hours and presents a new, approved two-hour professional session once. Course credit is 12 hours; presentation credit is 2 times 2, or 4 hours, for 16 CE hours total. Presenting the same subject again during that renewal period adds zero presentation hours. The PTA remains 4 hours short of the ordinary 20-hour requirement.
Watch the distinction: Repeating a presentation does not multiply credit indefinitely. Maryland allows presentation credit for the same subject only once per renewal period, subject to the activity’s approval.
21. Compact privilege in Maryland
A compact privilege lets a PT or PTA licensed in a compact member home state practice in another member state under that state's law. To obtain an initial Maryland privilege, the clinician must hold a home-state license, meet the compact's eligibility conditions, complete Maryland's jurisprudence requirement, and obtain the privilege before seeing Maryland patients. A home-state license alone does not supply Maryland authority. Under the Maryland legal reference, practice occurs where the patient is located during the encounter, including a video visit. A clinician using a Maryland privilege must therefore follow Maryland's scope, supervision, documentation, and telehealth rules. The privilege remains tied to the home license's expiration and continuing eligibility. Maryland can act against the Maryland privilege for conduct within its regulatory authority.
Worked example: A PT lives in a compact member state, holds an eligible home-state license, passes the Maryland JAM, and obtains an initial Maryland compact privilege. The PT then treats a patient by video while the patient is at home in Baltimore. Baltimore is the patient's location, so the encounter is Maryland practice. The PT must follow Maryland's telehealth and patient-care requirements, even though the PT is physically elsewhere.
Watch the distinction: A home-state license does not automatically authorize Maryland visits. The clinician needs the Maryland compact privilege, and the patient's Maryland location determines which state's practice rules govern.
22. An incomplete application is not authority
Separate an application from authority to practice. Maryland requires an applicant to complete the licensing process within one year of the paid application; otherwise, the applicant must reapply. Payment, graduation, a passing examination score, and a pending application are each evidence toward licensure, but none alone is a license. The national physical therapy examination guide addresses an examination that serves a different purpose from Maryland's authorization decision. Before treating, identify the actual authority held: a Maryland license, a valid temporary license with its supervision limits, or an applicable compact privilege. Maryland may refuse a license to an applicant who begins PT or PTA practice before licensure. The Board also cannot issue a license before receiving the required criminal history information. An incomplete file must be finished through the proper application route, not treated as provisional permission.
Worked example: A PTA graduate paid an application fee 14 months ago but never supplied all required material. Fourteen months exceeds the one-year completion period, so the applicant must reapply. A clinic offers a caseload while the new application is pending. The graduate cannot begin PTA treatment on the strength of either fee payment; Maryland practice requires issued authority, such as an effective license or a valid temporary license used within its limits.
Watch the distinction: A receipt proves payment, not permission to treat. The one-year application period is a completion deadline, not a year of provisional practice authority.
Patient Care Management
23. Evaluation before treatment
The PT evaluates the patient and develops a plan of care before treatment begins. Evaluation joins history and objective findings with clinical interpretation: what impairments matter, whether PT is appropriate, and which interventions can reasonably address the patient's functional needs. A referral can identify a concern or request a service, but it does not replace the PT's assessment. Maryland also allows a PT to decline a referred evaluation or treatment when, in the PT's judgment, it is contraindicated or unjustified, provided the decision is documented in the patient's record. Distinguish a clinical decision to withhold an unsuitable intervention from simply leaving a patient without direction. The PT should record the pertinent findings and reasoning, communicate the decision appropriately, and determine whether another evaluation or service is warranted. A PTA may carry out an established plan but cannot perform the PT's initial evaluation or create it.
Worked example: A referral requests resisted leg exercise after a patient reports new, unexplained weakness. During evaluation, the PT finds a marked change from the reported baseline and concludes that strengthening is not justified yet. The PT records the symptoms, findings, and reason for declining that intervention, then directs the patient toward appropriate further assessment. The referral does not obligate the PT to provide the requested exercise.
Watch the distinction: A signed referral is not a treatment plan. The PT must evaluate first and may document a sound clinical reason for declining a requested intervention.
24. The PT’s plan of care
A plan of care translates the PT's interpretation of examination findings into treatment aimed at anticipated functional goals. Reason from problem to goal to intervention: identify the limiting impairment, describe the activity the patient needs to improve, then choose procedures and a visit schedule that address that relationship. Maryland's initial documentation rule calls for goals and a plan that states suggested modalities or procedures, visits per week, and number of weeks. A list of exercises alone leaves unclear why they were selected, what success would look like, and when progress should be judged. The PT establishes and changes the plan and remains ultimately responsible under Maryland's handoff rule. A PTA follows the PT's direction and may record objective findings and responses, but cannot independently interpret those findings to redesign treatment. Changes in status should prompt communication and, when needed, a PT decision.
Worked example: A patient wants to climb one flight of stairs but has reduced knee motion and difficulty controlling descent. A plan reading only “leg exercises” omits the functional target and treatment schedule. The PT establishes a stair-related goal, selects interventions linked to the measured deficits, and records visit frequency and duration. A PTA can carry out authorized treatment and report progress, but cannot create the missing plan.
Watch the distinction: A procedure list is not a complete plan of care. It needs a reasoned link to functional goals, and the PT must establish or change it.
25. When reevaluation is due
Reevaluation asks whether the patient's condition and response still support the existing plan. The PT compares current tests, measurements, and functional assessments with earlier findings, interprets progress or lack of progress, and updates goals or treatment when warranted. Maryland requires reevaluation as the patient's condition requires and at least every 30 days unless the PT documents an appropriate rationale for not reevaluating, consistent with accepted standards of care. Thus a meaningful change can require action before day 30; a stable course does not silently erase the interval rule. Count the elapsed time from the last evaluation or reevaluation, then look for either a completed PT reevaluation or a documented, clinically appropriate rationale for deferring it. A PTA's measurements may inform this decision, but measurement alone is not the PT's reevaluation because interpretation and plan decisions remain with the PT.
Worked example: A patient's last PT evaluation was 32 days ago. The PTA reports that the patient feels unchanged and has continued the same exercises. Because 32 days exceeds the 30-day interval, the PT should reevaluate or document an appropriate clinical rationale for not doing so. The PTA's report may supply useful facts, but it does not itself fulfill the PT's reevaluation duty.
Watch the distinction: Thirty days is not a reason to ignore earlier deterioration. It is the maximum routine interval unless the PT documents an appropriate rationale for deferral.
26. Patient volume per treatment hour
Maryland limits a PT or PTA to an average of three patients per clinical treatment hour per calendar day, excluding group therapy. A clinical treatment hour is a 60-minute increment in the sequence that starts with the day's first service and ends with the last; the final increment may be fractional. To assess the daily average, count the relevant non-group patient services and divide by the applicable clinical treatment hours. Do not count group-therapy patients in the numerator for this limit. Then check the separate duty to give each patient adequate treatment time: an average below three does not excuse rushed care. The Maryland JAM content outline identifies patient care management as a tested area; the numerical rule comes from Maryland's standards of practice. Keep the PT's and PTA's daily services separate when assessing each clinician.
Worked example: A PT provides 13 patient services over four clinical treatment hours. Two services are group therapy, so the count for this average is 13 minus 2, or 11. Divide 11 by 4 hours to get 2.75 patients per clinical treatment hour. That is below Maryland's limit of three. The PT must still allow adequate treatment time for every patient.
Watch the distinction: Counting group patients in the numerator can falsely suggest a violation. Conversely, a compliant daily average does not establish that each patient received adequate care.
27. Before a PTA starts treatment
A Maryland PTA may not initiate a patient's treatment until two prerequisites are in place. First, a PT must evaluate the patient and develop the plan of care. Second, a supervising PT must be assigned to the PTA. Check both separately because a completed plan does not identify who will provide the ongoing direction and instruction needed for safe limited physical therapy. Once treatment begins, the PTA follows the PT's plan, works within PTA scope and personal competence, and communicates changes that may affect the plan. An assigned PT cannot be merely a name on a schedule; supervision must support the patient's safety and welfare through continuing contact. If either prerequisite is absent, pause the proposed PTA treatment and resolve it before proceeding. Administrative convenience, prior experience with a similar diagnosis, or a referral cannot substitute for the patient's PT evaluation and assigned supervisor.
Worked example: A PT evaluates a postoperative patient, writes a plan, and leaves for the day. A PTA is asked to provide the first treatment, but the clinic has not assigned that PTA a supervising PT for the case. One prerequisite is met and the other is missing. The PTA waits until supervision is assigned; the existence of a written plan does not authorize treatment by itself.
Watch the distinction: The PTA's own skill does not remove either prerequisite. Maryland requires both a PT evaluation and plan, and an assigned supervising PT, before PTA treatment starts.
28. Measurements versus clinical interpretation
Maryland's limited physical therapy scope permits a PTA to take and document measurements but excludes interpreting measurements and planning treatment programs. The distinction is the clinical inference drawn from the data. Recording a gait speed, range of motion, or strength measure states what was observed; deciding what a decline means for diagnosis, goals, or a revised plan is PT work. A PTA can and should notice a meaningful change, use sound judgment while performing authorized treatment, and communicate it to the supervising PT. The PT then interprets the finding in the context of other evidence and decides whether reevaluation or a plan change is needed. Avoid treating a single number as self-explanatory: testing conditions, patient effort, symptoms, and prior values affect interpretation. Documentation should preserve the measurement and relevant context so the PT can make a defensible decision.
Worked example: A PTA measures walking speed at 0.8 metres per second on Monday and 0.5 metres per second on Friday using the same walkway. The decrease is 0.3 metres per second, or 37.5% of Monday's value. The PTA records the method, result, and observed symptoms and informs the PT. The PT determines whether this reflects a meaningful clinical decline and whether to change the plan.
Watch the distinction: A measured difference does not grant the PTA authority to diagnose its cause or revise goals. The PTA reports the finding; the PT interprets it.
29. Ongoing PTA supervision
Ongoing supervision means the PT maintains continuing verbal and written contact with the PTA and provides instruction adequate for the patient's safety and welfare. The necessary contact depends on the case: a stable response may need less immediate discussion than a new symptom that makes the planned treatment questionable. The PT delegates only treatment within the PTA's scope and competence, supplies sufficient direction, and documents communication about changes in patient status and the treatment plan. The PTA follows the established plan, exercises sound judgment, and reports changes rather than quietly improvising a new course. Ongoing supervision should not be confused with direct supervision, which requires the PT's physical presence in the treatment area. When a new concern arises, decide whether continuing the existing intervention is safe, communicate with the PT, and obtain direction before proceeding when the plan's appropriateness is uncertain.
Worked example: During a planned balance session, a patient tells the PTA that dizziness began that morning. The PTA stops the exercise that could increase fall risk and contacts the supervising PT with the symptom and objective observations. The PT considers whether the plan remains appropriate and gives further direction. Both document the relevant communication and resulting treatment decision rather than treating the old plan as automatic permission.
Watch the distinction: A PT's phone availability can support ongoing supervision, but an unanswered concern does not become safe merely because the PT was theoretically reachable.
30. Responsibility when care changes hands
Maryland places ultimate responsibility for patient care on the PT who establishes or changes the plan until another PT either provides services to that patient or supervises the treating PTA. This rule prevents responsibility from becoming vague when schedules or personnel change. To reason through a handoff, identify who last established or changed the plan, then ask whether another PT has actually met one of those two transfer conditions. A PTA's treatment under the plan does not, by itself, transfer ultimate responsibility to the PTA. Nor does a colleague's presence somewhere in the clinic necessarily show that the colleague has taken over supervision of this PTA. Clear assignments, access to the plan and recent findings, and documented communication make the handoff workable. The incoming PT must have enough information to direct care safely; the PTA still practices under assigned ongoing supervision.
Worked example: PT A evaluates a patient and writes the plan. The next day, a PTA treats the patient while PT A is absent; PT B is working elsewhere in the clinic but has not provided services to this patient or assumed supervision of the PTA. PT A's ultimate responsibility under the handoff rule continues. If PT B takes over the PTA's supervision for this case, responsibility transfers under that condition.
Watch the distinction: A schedule change alone is not the legal handoff. Another PT must provide services to the patient or supervise the treating PTA.
31. Direct supervision of students
A student may participate in patient care within a Board-approved educational program, but Maryland requires direct supervision by a licensed PT. Direct supervision has a physical component: the PT must be present in the treatment area and immediately available to provide aid, direction, and instruction while procedures occur. A phone call, message, or presence elsewhere in the building does not meet that definition. The PT also must determine the student's ability to perform assigned duties and periodically reassess it, so proximity alone is not enough. Match the task to the student's demonstrated ability, remain in the treatment area, and intervene when patient safety or clinical judgment requires it. This educational exception does not make the student an independently licensed clinician. A PTA may participate in a PTA student's clinical education activities, but the regulation still requires the PT to provide the student's direct supervision.
Worked example: A PT student is conducting gait training while the supervising PT works on another floor and offers to answer calls. The PT is absent from the treatment area, so the arrangement fails Maryland's direct-supervision requirement. The PT must return to the treatment area and be immediately available before the student continues. The student's prior successful sessions do not change the required supervision level.
Watch the distinction: Immediate availability means more than being reachable by phone. For student care, the supervising PT must be physically present in the treatment area.
32. Preparing an aide for assigned treatment
Before an aide performs a permitted treatment task, Maryland requires documented evidence of sufficient in-service training for safe performance and direct PT supervision during the treatment. The PT must also determine and periodically reassess the aide's ability to perform assigned duties. These safeguards address different questions: training establishes preparation, assessment checks actual ability, and direct supervision places the PT in the treatment area and immediately available during the task. An aide's job title or informal observation of another worker establishes none of them. Start by checking whether the proposed activity is on Maryland's permitted aide list; then verify task-specific training, current ability, and the required supervision. The aide assists with listed activities and does not evaluate patients or choose treatment. If the patient's condition changes or the task becomes more complex, the PT should reconsider whether it remains appropriate to assign.
Worked example: An aide watched one hot-pack application and is asked to assist with the next patient's pack while the PT treats someone in another room. Observation alone supplies no documented evidence of sufficient training, and the PT is outside the treatment area. Before assigning the listed activity, the PT documents adequate in-service preparation, checks the aide's ability, and provides direct supervision during the assistance.
Watch the distinction: A task can appear simple yet still require documented training and direct PT supervision when an aide performs it as treatment.
33. Aide activities without direct supervision
Maryland identifies limited aide activities that can occur without direct supervision because they are not treatment. Examples include clerical and housekeeping work, transporting patients, helping with dressing, and removing or applying assistive or supportive devices. An aide may also help a PTA when another person is needed for safety during ambulation, transfers, or functional activities without direct PT supervision. Classify the actual action, not merely its location near a patient. Moving someone to the treatment area is transport; directing a therapeutic gait exercise is treatment. Once an aide performs a listed treatment activity, direct PT supervision is required. The exception for helping a PTA with safety supplies an extra person for a particular activity; it does not authorize the aide to lead that therapy or make clinical decisions. If the activity shifts during the encounter, reassess the supervision requirement at that point.
Worked example: An aide transports a patient to the gym and removes a supportive brace while the PT is elsewhere. Those patient-related tasks do not involve treatment and may occur without direct supervision. The patient then asks the aide to lead the prescribed walking exercise. That would be treatment, so the aide cannot independently proceed; any permitted assistance with gait practice requires direct PT supervision.
Watch the distinction: Being near a patient does not make every aide task treatment. Once the aide begins therapeutic activity, the non-treatment exception no longer covers the work.
34. The aide’s permitted treatment list
Maryland permits aides under direct PT supervision to assist with a defined list of treatment activities, including gait and ambulation practice, functional activities, transfers, routine follow-up of specific exercises, and listed physical-agent applications or procedures. The list is a boundary, not a general delegation clause. An aide cannot evaluate a patient or perform a treatment outside that list, even if the PT is present and the aide has been trained. Read proposed assignments by action: “assist with routine follow-up of this specific exercise” can fit; “decide which exercise treats new shoulder pain” requires evaluation and treatment planning. The Maryland JAM practice questions can help rehearse this classification. Direct supervision and documented training remain necessary for a permitted treatment task. A PT's presence addresses supervision; it does not expand the aide's legal scope.
Worked example: A PT directly supervises an aide assisting a patient through a previously specified exercise routine. That assistance fits the listed routine-follow-up activity if training and ability are established. When the patient mentions new shoulder pain, the PT asks the aide to test the shoulder and select replacement exercises. The aide must decline those assignments: evaluation is prohibited, and choosing new treatment exceeds the listed aide activities.
Watch the distinction: Direct supervision does not make every assignment permissible. First determine whether the task is listed for aides; evaluation remains prohibited in all cases.
35. Stopping harmful or refused treatment
A PTA must immediately discontinue a treatment procedure that appears harmful and notify the supervising PT. The PTA must also respect the patient's right to refuse treatment. These duties work together but arise from different cues: apparent harm requires the PTA to stop even if the patient wants to continue; an informed refusal requires stopping even if the PTA believes the procedure is beneficial. First secure the patient and end the concerning procedure. Then gather and record relevant observations, notify the supervising PT about apparent harm, and follow the PT's direction for subsequent care within the existing scope and plan. Do not pressure a patient to continue or treat silence as agreement after a clear refusal. The PT may need to reassess the patient or plan. Documentation should state what occurred, the patient's response or refusal, the PTA's action, and the communication that followed.
Worked example: During a PTA-led exercise, a patient reports sharp pain and says, “I do not want to continue.” The PTA stops immediately, helps the patient to a safe position, records the reported symptom and observable response, and promptly informs the supervising PT. The PTA does not resume the exercise simply because it was prescribed. The PT decides what assessment or plan change is appropriate.
Watch the distinction: A written plan does not override apparent harm or a patient's refusal. The PTA stops the procedure and informs the supervising PT of the concern.
36. The initial evaluation record
An initial PT record should show how the clinician moved from patient history and testing to a justified plan. Maryland requires the visit date; condition or diagnosis; onset; pertinent history if not already recorded; measurable, objective evaluation findings; interpretation; goals; initial procedures with parameters and body areas; a plan with proposed procedures, visits per week, and number of weeks; and the PT's signature, title, and license number. The reasoning link matters: a measurement describes performance, while interpretation explains its significance for the functional problem and selected care. Procedure parameters make the treatment reproducible and allow later comparison. Frequency and duration give the plan a defined course rather than an open-ended exercise list. Record clinically relevant facts with enough specificity to support later reevaluation, while avoiding unsupported conclusions. The initial evaluation and plan belong to the PT, even if a PTA later treats under that plan.
Worked example: An initial note says only, “Knee pain; exercise started.” It gives no onset, objective test result, interpretation, goal, exercise parameter, treated area, or visit schedule. The PT measures knee motion, records the finding and its functional meaning, states a stair-climbing goal, details the initial exercises, and specifies proposed frequency and duration. The completed note then identifies the PT with signature, title, and license number.
Watch the distinction: A diagnosis plus an exercise name does not document an evaluation. The note must show objective findings, interpretation, goals, treatment details, and a defined plan.
37. Progress notes after treatment
A progress note records the services and response at each subsequent visit so the treatment course can be reconstructed. Maryland requires the date, cancellations or no-shows when relevant, procedures and body areas, changes in treatment parameters, objective status, response to current treatment, plan continuation or authorized change, and the clinician's signature, title, and license number. For PTA visits, the note must distinguish continuing the PT's plan from a change the PT authorized. A parameter such as resistance, duration, or repetitions is useful only with enough context to identify what was performed and where. Objective status should describe a measurable or observable finding; the response states the patient's condition after treatment. If a new finding leads to a PT–PTA discussion, both clinicians document that communication. A flow chart may be initialed as allowed, but the required note still needs proper identification.
Worked example: Under a PT-authorized progression, a PTA increases a patient's exercise resistance from a hypothetical 2 kilograms to 3 kilograms, a 1-kilogram increase. The PTA records the date, exercise and body area, new resistance, observed performance, and the patient's response after treatment. The note states that care continued under the PT's authorized plan and carries the PTA's signature, title, and license number.
Watch the distinction: Writing “tolerated treatment” alone leaves the service and its parameters unclear. A progress note must identify what was done, observed, and changed.
38. Reevaluation and discharge records
A reevaluation and a discharge summary answer different questions. In reevaluation, the PT compares current tests and measurements with prior findings, interprets the change, identifies goals met or unmet and why, then updates goals and the plan, including follow-up recommendations. Maryland also calls for the date and number of treatments since the initial evaluation or last reevaluation. At discharge, the PT records the date, reason for ending care, objective status, recommendations for follow-up, and identifying signature. A discharge summary may be combined with the final visit note when the PT sees the patient on that visit and writes it. The PT may instead direct a PTA to treat the final visit; that does not transfer authorship of the discharge summary to the PTA. Distinguish a final treatment entry from the PT's synthesis of the episode of care.
Worked example: After six visits, a PT measures knee flexion at 112 degrees versus 96 degrees initially, an improvement of 16 degrees. The PT interprets that change against the stair-climbing goal, records whether the goal was met, and updates the plan. Later, when care ends, the PT writes the discharge reason, current objective status, and follow-up advice. A PTA's final treatment note does not replace that summary.
Watch the distinction: A reevaluation is more than a fresh measurement, and a final PTA visit note is not the PT's discharge summary.
39. Signatures and team communication
Maryland defines a clinical signature as the PT's or PTA's own written or compliant electronic signature followed by the professional title and Maryland license number. A signature stamp is not acceptable. This identifies who performed and documented care, which matters when PT and PTA responsibilities differ. Both clinicians must document their ongoing communication about changes in a patient's status and treatment plan. A useful entry states the new finding, when and how it was conveyed, the PT's direction, and what treatment followed. The PTA should not silently translate a conversation into an independently revised plan; the PT's decision and authorization should be clear. The PT should likewise document the communication rather than relying solely on the PTA's note. Maryland permits initials on a flow chart, but that limited allowance does not replace the required signed clinical documentation.
Worked example: A PTA observes a new limp and calls the supervising PT before continuing gait work. The PT directs a change within the plan and decides whether further assessment is needed. The PTA records the observation, call, direction, and treatment response; the PT documents the same clinical communication and decision. Each signs their own entry with PT or PTA title and Maryland license number, without a signature stamp.
Watch the distinction: A shared chart does not make one clinician's note a substitute for both clinicians' required communication records. A stamped signature is insufficient.
40. Qualifying to perform dry needling
Maryland reserves dry needling for licensed PTs; it is outside PTA scope. Before performing it, a PT must have practiced physical therapy for at least two years, complete at least 80 hours of required instruction, pass the instruction's competency assessments, and register with the Board. The 80 hours include at least 40 hours of specified dry-needling course content and 40 hours of supervised hands-on instruction. The practical portion cannot be completed through distance learning. Maryland also specifies qualified course sponsors and instructor qualifications for the hands-on portion, so an arbitrary workshop may not satisfy the training rule. Registration must occur before practice, even when experience and coursework are complete. At the point of care, the intervention must address a linked neuromuscular or musculoskeletal impairment within PT scope; the PT must explain it, obtain specific written informed consent, and document the service. These treatment duties do not replace the qualification prerequisites.
Worked example: A Maryland PT has practiced for two years and completed 40 hours of qualifying course content plus 40 supervised hands-on hours, with competency assessments. The totals meet the 80-hour training structure, but the PT has not registered with the Board. The PT cannot perform dry needling yet. After registration, the PT must still establish a relevant PT purpose, explain the procedure, obtain specific written consent, and document each service.
Watch the distinction: Completing a course does not by itself authorize dry needling. PT status, experience, qualifying training, competency assessment, and Board registration all matter.
41. Dry needling at the point of care
Dry needling is a physical therapy intervention for an impairment with a neuromuscular or musculoskeletal link to the body area treated. It involves inserting solid needles into muscle or related tissue, with continuing assessment of the impairment. It is not a way to provide acupuncture or another service outside physical therapy. In Maryland, only a PT who meets the practice, training, competency, and Board registration requirements may perform it; a PTA cannot. At the visit, the PT explains the proposed procedure before treatment and obtains written informed consent specific to dry needling for the medical record. The PT then documents the service under the ordinary physical therapy documentation rules, including the treatment performed and the patient's response. The Maryland legal reference sets out these distinct requirements.
Worked example: A registered PT identifies a muscle impairment linked to a patient's functional limitation and proposes dry needling as part of the plan. The patient signed a general intake consent last week. Before inserting a needle, the PT explains dry needling, obtains a separate written consent specific to it, and places that consent in the record. The PT documents the treated area, procedure, and patient response.
Watch the distinction: A general consent to physical therapy does not satisfy the dry needling requirement. Written consent must address dry needling specifically, even when the PT is registered and the intervention fits the plan.
42. Setting up a telehealth encounter
Before a telehealth visit, the Maryland PT or PTA needs a procedure for identifying the patient, disclosing the practitioner's name, authorization type and number, and contact information at an initial encounter, and obtaining the required patient or guardian consent. That consent includes information about the recommended plan's risks, benefits, and side effects. Clinical information must travel through a secure, private method, with unauthorized access prevented and a process for notifying patients of a breach. An emergency plan needs contact information for services where the patient is located. For a live encounter, the practitioner also confirms a backup contact method, whether the patient is in Maryland, the patient's specific setting, and everyone present who can hear health information. The same practice and documentation standards apply remotely. MD JAM practice questions can help rehearse that sequence.
Worked example: At a first video visit, a PT verifies the patient's identity using a permitted document and confirms that the patient is at home in Maryland. The PT provides a name, Maryland license type and number, and contact details; explains the proposed care and obtains consent. After identifying a family member in the room, the PT confirms the patient's permission for that person to hear the visit and records a backup number and local emergency contact.
Watch the distinction: A secure video connection alone does not complete telehealth setup. Identity, initial practitioner disclosures, consent, privacy, and emergency arrangements still matter, with additional location and bystander checks for live visits.
43. Telehealth evaluation and referral
A remote format does not remove the PT's duty to evaluate before developing a treatment plan. Maryland allows a synchronous or asynchronous clinical evaluation when it is appropriate to the patient's condition, but forbids treatment based solely on an online questionnaire. The decision turns on whether the available history, observation, measurements, and clinical interaction support a sound evaluation and safe plan. If essential findings cannot be obtained remotely, the PT should arrange an in-person assessment or refer to another appropriate service. A PTA may contribute observations within limited physical therapy practice, but cannot take over evaluation, interpretation, or planning. Sudden severe symptoms also change the urgency of referral. Clinical reasoning covered in an NPTE-PTA guide helps identify changes worth reporting; the Maryland PT remains responsible for evaluating and planning care.
Worked example: A new patient checks a box for sudden severe leg weakness on an intake questionnaire. A PT does not prescribe remote strengthening from that answer. The PT contacts the patient, clarifies onset and accompanying symptoms, and recognizes that the available remote information cannot support a safe rehabilitation plan. The PT directs the patient to an appropriate prompt medical assessment, documenting the concern and referral.
Watch the distinction: An online questionnaire may supply useful history, but it is not, by itself, the clinical evaluation Maryland requires before telehealth treatment planning. A PTA cannot fill that gap by independently creating a plan.
Disciplinary Actions and Unlawful Practice
44. Unauthorized practice and protected titles
Maryland treats practicing, attempting to practice, and offering to practice as separate routes to unauthorized practice. A person generally needs Maryland authorization before providing or advertising physical therapy or limited physical therapy in the state. Title rules add a second question: does the person's public description represent that they hold a Maryland PT or PTA license? Using PT or PTA letters with that intent is restricted to the corresponding authorization. A degree, completed application, or future start date does not itself grant authority. For each scenario, identify the service offered, the claimed role, and the person's actual license or compact privilege. The PT and PTA categories are distinct: a PTA authorization permits limited physical therapy under PT direction, not independent PT evaluation and planning. The Maryland JAM outline lists lawful practice within patient care management.
Worked example: A graduate awaiting a Maryland license posts, “Maryland PT appointments available next week,” and accepts bookings for evaluations. No patient has yet been seen. Offering the evaluations already raises an unauthorized-practice issue, while “PT” may separately represent licensed status. The graduate should remove the offer and title claim until the required Maryland authorization is effective.
Watch the distinction: Waiting to treat the first patient does not make an unauthorized advertisement harmless. Maryland's practice restriction reaches offers and attempts, while its title provisions address representations of licensed PT or PTA status.
45. Fraudulent credentials and advertising
Two forms of deception can occur in one advertisement. Fraudulently obtaining or using a license concerns the credential that supposedly authorizes practice; using someone else's number makes the public and the Board associate services with the wrong licensee. Misleading advertising concerns what the advertisement claims about services, qualifications, or results. A licensee can violate that rule even while using their own valid number, such as by claiming a specialty certification they never earned. Analyze each statement separately: whose authorization is shown, whether it is valid for the person and role, and whether the remaining claims are truthful. The Board may consider fraudulent license use and deceptive promotional matter as disciplinary grounds. Correcting a page later helps stop continued misrepresentation but does not erase the earlier conduct.
Worked example: A clinic profile identifies a Maryland PTA with a colleague's PT license number and says the PTA holds an advanced certification never earned. The number falsely ties the profile to another person's PT authorization. The certification claim independently misleads patients about qualifications. The clinic should remove both claims, verify who approved the profile, and correct any records or patient communications affected.
Watch the distinction: A borrowed number is not merely a formatting error when used to represent professional authority. Also, a genuine license number would not make a false certification claim acceptable.
46. False records and billing
A clinical record should reflect what happened, including cancellations and no-shows where the documentation rule calls for them. Maryland identifies several distinct problems: willfully making a false practice record, submitting a false statement to collect a fee, and concealing patient or billing information that could serve as evidence. The sequence matters. An erroneous entry can be corrected transparently, preserving an accurate trail; deleting a cancellation to support billing for a visit that never occurred suggests deliberate concealment. Compare the appointment record, treatment note, and claim before deciding what each document represents. A PTA who documents care remains responsible for the accuracy of that entry within the PTA role. The Board may treat false billing and documentation as separate disciplinary categories, depending on the facts.
Worked example: A patient cancels Tuesday's PTA visit before treatment begins. The schedule records the cancellation, but a claim later lists a completed visit. When asked about the claim, the PTA deletes the cancellation entry. The claim seeks payment for care not delivered; the deletion obscures evidence of what occurred. The proper correction is an accurate cancellation record and withdrawal or correction of the false claim.
Watch the distinction: Deleting an entry is not a harmless way to fix a billing mismatch. A transparent correction preserves the history; deliberate removal to hide a cancelled visit creates an additional concern.
47. Sexual misconduct in care
Maryland's sexual-misconduct rule covers more than physical contact. It includes soliciting a sexual relationship with a patient, sexual comments or advances, inappropriate touching, and conduct presented as therapeutic when its purpose is sexual. The professional setting creates an imbalance of trust and authority, so a patient's apparent agreement to a date does not remove the prohibition on solicitation during care. Evaluate the conduct by its context and purpose: whether the person is a patient, whether the interaction occurs in professional evaluation or treatment, and whether the act has a legitimate therapeutic reason. Consent to a clinical procedure covers that procedure, not a personal relationship. Both PTs and PTAs are bound by the rule. A clinician should maintain clear treatment boundaries and document only clinically relevant contact.
Worked example: During a treatment visit, a PT asks a current patient to go on a date after discharge. The patient says yes, and the PT argues that no misconduct occurred because the invitation was welcomed. The invitation is still solicitation of a sexual relationship with a patient in a professional context. The PT should stop pursuing the relationship; the patient's response does not change the classification of the request.
Watch the distinction: A patient's agreement does not turn a clinician's solicitation into acceptable treatment conduct. Maryland's rule expressly covers solicitation of a relationship with a patient, whether consensual or nonconsensual.
48. Impairment and safe practice
Maryland separates unsafe conduct from the investigation of a possible underlying condition. Providing professional services while under the influence of alcohol or certain drugs is a disciplinary ground. Habitual substance use to an extent that impairs professional competence, and professional, physical, or mental incompetence, are also grounds. During an investigation, good cause to believe a physical or mental condition may adversely affect practice allows the Board to require an appropriate examination, test, or evaluation by a designated provider. The Board pays for that evaluation. A report of unusual behavior alone is an allegation; evidence of treatment circumstances, observed impairment, and patient risk determines the next step. Refusing a required evaluation may itself be considered evidence of inability to practice competently, unless the refusal was beyond the licensee's control.
Worked example: Two coworkers report that a PT smelled of alcohol, stumbled, and treated patients on several mornings. The Board investigates dates, witnesses, and care records rather than assuming every report is proven. Treating while intoxicated may support discipline. If the investigation gives good cause to believe a condition affects safe practice, the Board may require an appropriate evaluation by its designated provider.
Watch the distinction: The Board does not need to prove a particular diagnosis before examining a credible safety concern. Its evaluation authority depends on good cause concerning the effect of a condition on practice.
49. Referral payments and patient exploitation
A referral should be guided by the patient's needs, not a payment for sending business to a PT. Maryland lists paying or agreeing to pay any person for bringing or referring a patient as a disciplinary ground. Equipment decisions have a different test: supplying physical therapy equipment must serve the patient's best interest, and promoting goods to exploit a patient for financial gain is prohibited. A clinic may recommend a useful device when findings justify it; the record should explain the clinical purpose and allow the patient to understand the choice. Look for two separate financial incentives in a scenario: money flowing to a referral source and profit influencing what is sold to a patient. Either can distort independent professional judgment, even if some patients would benefit from treatment.
Worked example: A PT offers a physician money for each patient referred and then tells every referred patient to buy the clinic's expensive brace. One patient has no documented need for a brace. The payment for referrals is a separate disciplinary issue from promoting unnecessary equipment for financial gain. The PT should end the payment arrangement and base any device recommendation on individual findings.
Watch the distinction: Selling equipment is not automatically prohibited. The problem arises when the choice does not serve the patient's best interest or the clinician exploits the patient for financial gain.
50. Reporting unsafe or illegal practice
Maryland's code of ethics requires both PTs and PTAs to report to the Board information indicating that someone is allegedly performing, or helping another perform, illegal or unsafe physical therapy practice. “Allegedly” matters: the clinician reports credible information, while investigation and findings belong to the Board. A useful report identifies what was observed, who performed the work, the dates or patients involved if known, and why the activity appears unauthorized or unsafe. It should distinguish firsthand observations from statements learned from others and protect patient information during transmission. Telling a coworker to stop may limit immediate risk but does not replace the reporting duty. If patients face an immediate danger, the clinician should also act within their role to prevent continued unsafe treatment.
Worked example: A PTA sees an unlicensed employee perform two independent initial evaluations and hears the employee assign treatment plans. The PTA records the observed dates and activities, alerts the appropriate clinical supervisor to stop the unsafe assignment, and reports the information to the Board. The Board determines whether a violation occurred; the PTA need not prove the case before reporting.
Watch the distinction: Reporting is not reserved for confirmed violations or for PTs alone. A PTA with information indicating alleged illegal or unsafe practice has the same Board reporting duty.
51. Address and outside-discipline notices
Maryland requires two different written notices that are easy to confuse. Every licensee must give the Board immediate written notice of an address change, so official communications can reach the required address. A PT or PTA whose physical therapy license or similar practice authorization in another state is limited, restricted, suspended, revoked, or otherwise disciplined must notify Maryland in writing within 60 days. The latter clock concerns the outside authority's action, not the date Maryland discovers it. These duties are independent: an updated address does not disclose discipline, and a discipline notice does not necessarily update contact information. When reviewing a scenario, identify the event, the correct notice content, its recipient, and the applicable timing. Do not assume a routine renewal form replaces either notice.
Worked example: A PT moves on April 3 and learns on May 10 that another state has restricted the PT's license. The PT sends Maryland written notice of the new address immediately after moving. The PT also sends a separate written notice describing the outside restriction within 60 days of that disciplinary action. Waiting until biennial renewal would miss the purpose of both notices.
Watch the distinction: The 60-day period applies to notice of another state's discipline, not to address changes. Maryland requires immediate written notice when the licensee's address changes.
52. Cooperating with an investigation
A lawful Board investigation depends on access to relevant information and honest participation. Maryland makes willful failure to cooperate without legal justification a disciplinary ground, and its code of ethics prohibits hindering or delaying someone from providing information to the Board. It also prohibits concealing records for use as evidence or pressuring a person to alter testimony. Evaluate whether the request is lawful, what material is responsive, and whether the licensee intentionally blocks access. A legitimate question about a request can be raised through proper channels; it does not justify instructing staff to hide charts. Cooperation does not determine the outcome of the original complaint, but obstruction can become a separate violation. Preserve records and a clear account of what was supplied and when.
Worked example: The Board lawfully requests records for visits named in a patient complaint. A PT tells the records clerk to omit two relevant charts so the Board will not see missed reevaluations. Even if the original complaint is later unsubstantiated, the deliberate instruction to withhold responsive records can support action for obstructing the investigation. The charts should be preserved and provided through the proper process.
Watch the distinction: A licensee cannot justify hiding records by believing the complaint is unfair. The underlying allegation and a willful refusal to cooperate are separate questions.
53. From complaint to formal charge
A complaint starts a process; it is an allegation, not a Board finding. After reviewing investigative material, the Maryland Board can dismiss the complaint, close it with an informal letter of education or admonishment, issue a cease and desist order, investigate further, refer it for prosecution, or begin formal action through charges. An education letter closes a case when the conduct is not believed to rise to a Practice Act violation; an admonishment is an informal, nonpublic closure when the Board believes a violation occurred. Formal charges are nonpublic documents that state alleged facts and legal grounds and notify the respondent of proceedings. A final order, including a consent order, resolves formal action. Sort each document by stage and legal effect before inferring discipline from its name.
Worked example: A patient complains that a PTA changed a plan without authorization. Investigation shows the PT approved the change but communication was poorly documented. The Board could close the matter with education, investigate further, or issue charges if facts support a violation. The complaint itself proves none of those outcomes. Only the Board's later action establishes how the case was resolved.
Watch the distinction: A filed complaint is not a sanction. Even a nonpublic informal letter differs from formal charges and a final disciplinary order.
54. Hearings and recommended decisions
When the Board issues charges, notice identifies the alleged facts, legal basis, and hearing. For an ordinary hearing, written notice goes to the parties at least 30 days beforehand; show cause hearings follow a separate process. At an evidentiary hearing, parties can submit relevant evidence and examine witnesses. The Board may delegate that hearing to a committee or an administrative law judge, who prepares a recommended decision for Board consideration. That recommendation is not yet the Board's final order. The parties may file written exceptions within 30 days after receiving it; the opposing party has 15 days to respond. Timely exceptions lead to oral argument before a Board quorum, after which the Board issues its order. Follow this sequence to identify when allegations, proposed findings, and binding disposition arise.
Worked example: A hearing committee hears testimony and recommends probation. The PT receives the recommendation and disputes a factual finding. The PT files written exceptions within 30 days of receipt. The opposing party may respond within 15 days, and timely exceptions lead to oral argument before the Board. The committee's proposed probation does not become the final disposition until the Board issues its order.
Watch the distinction: A hearing committee's recommended decision is not the Board's final order. The exception and Board review stages still matter, even after witnesses have testified.
55. Confidential proceedings and public orders
Maryland protects the confidentiality of Board disciplinary proceedings and hearings, including an administrative law judge's recommended decision. The parties cannot simply waive that confidentiality, and patient identities reflected in the record remain protected. By contrast, a final order resolving formal discipline is a public record; consent orders and summary suspension orders are examples. The key is the status of the requested document, not whether a reporter knows a case exists. Charges are nonpublic, hearing records are sealed, and informal education or admonishment letters are nonpublic. A public final order still does not make the underlying patient charts or testimony freely available. When answering a disclosure question, classify each record, identify whether the action is pending or final, and preserve patient privacy even after closure.
Worked example: A reporter asks for the transcript of a pending disciplinary hearing and a signed consent order that resolved a different case. The hearing transcript remains confidential as part of the proceeding. The completed consent order is a public final order. If it discusses patient care, the Board and parties should still avoid unnecessary disclosure of patient identities.
Watch the distinction: A public final order does not open the entire investigative file. Confidential testimony, charges, and patient information retain their own protections.
56. Emergency summary suspension
A summary suspension addresses an immediate public-safety risk while the ordinary disciplinary process continues. Maryland's Board must determine a substantial likelihood that the licensee poses a risk of harm to public health, safety, or welfare. It may first issue a notice of intent and offer a show cause hearing. If the threat requires immediate suspension, it may issue the suspension order without that advance opportunity. The licensee must then receive a show cause hearing within a reasonable time to challenge continued suspension. If the Board continues it, the licensee may request an evidentiary hearing. A show cause hearing is an opportunity for argument; an evidentiary hearing develops testimony and other evidence. Summary suspension is a public final order, but it does not itself settle every underlying charge.
Worked example: An investigation produces evidence that a PT is likely to cause immediate patient harm if treatment continues. The Board determines the risk requires immediate action and orders summary suspension before a hearing. It then provides a show cause opportunity within a reasonable time. If it continues the suspension, the PT may request an evidentiary hearing; the immediate order does not eliminate that later process.
Watch the distinction: Advance notice is not required when the documented threat calls for immediate suspension. The licensee still receives a later opportunity to challenge the emergency action.
57. Sanctions, factors and probation
Maryland can respond to proven misconduct with a reprimand, probation, suspension, revocation, and, when authorized, a monetary penalty. Its sanction guidelines distinguish categories of violations, while mitigating and aggravating facts help the Board assess an appropriate result. Self-reporting, cooperation, and remediation may mitigate; concealment, repeated conduct, financial motive, or serious patient risk may aggravate. Probation is an active Board order, often requiring education, supervision, monitoring, audits, or other specified conditions. Completing a course or reaching the end of a stated period does not authorize a licensee to declare probation over. Release requires a petition to the Board when the order's time or conditions have been satisfied. A probation violation can trigger additional conditions or stronger action.
Worked example: Two PTs commit similar documentation violations. One promptly self-reports, corrects the record transparently, and cooperates; the other repeatedly hides missing notes. Those facts may affect the Board's sanctions. If either receives probation requiring chart audits for a stated period, the audits remain mandatory under the order. After satisfying the terms, that PT petitions the Board for release.
Watch the distinction: Similar violations do not guarantee identical sanctions. Case facts can change the result, and probation conditions remain enforceable until the Board releases the licensee.
58. Different monetary consequences
A disciplinary monetary penalty against a licensee and a civil fine for unauthorized practice serve different legal purposes. For practice on an expired PT or PTA license, Maryland permits a civil fine of $100 for each day the person actually practices after expiration. Count practice days, not simply calendar days since expiration. Practice without ever holding the required license falls under a different civil-fine provision, with an amount from $5,000 to $50,000 under the supplied rule; financial benefit, willfulness, risk, and duration can affect the amount. A licensee may also face professional discipline where grounds exist, but the categories should not be conflated. First identify whether a license existed and expired, then count actual practice days or analyze unlicensed practice, and finally consider any separate disciplinary grounds.
Worked example: A Maryland PTA license expires Sunday. The PTA treats patients on Monday, Wednesday, and Friday, then stops. There are three practice days after expiration, so the Board may assess 3 × $100 = $300 as a civil fine. Tuesday and Thursday do not add to that calculation because no practice occurred. Someone who never held a required license falls under the separate unlicensed-practice range.
Watch the distinction: An expired-license fine is based on days of practice, not every day the license remains expired. It also should not be replaced with the civil-fine range for someone who never held a license.
Consumer Advocacy
59. Dignity, privacy and patient choice
Maryland's PT and PTA code of ethics requires care without discrimination on listed personal characteristics and requires respect for each patient's dignity. It also protects confidential health information: disclosure needs patient or guardian consent unless law requires it. Separately, the standards of practice require both PTs and PTAs to respect a patient's refusal of treatment. Apply these duties in sequence. Explain the proposed treatment accurately, listen to the patient's decision, stop or adjust care when the patient refuses, and record the clinically relevant response. For an information request from a relative, identify whether the patient or guardian authorized that disclosure; family status alone is not permission. Privacy and refusal are related to trust, but one does not cancel the other. A refusal can alter the plan without opening the patient's record to others.
Worked example: A patient declines a planned stair exercise and asks the PTA not to discuss progress with a visiting sibling. The PTA stops the exercise, documents the refusal and relevant response, and informs the supervising PT if the plan needs review. The PTA does not give the sibling progress details merely because they arrived together. Disclosure would require appropriate consent or a legal requirement.
Watch the distinction: A family member's interest does not supply consent to receive confidential treatment details. Likewise, a signed treatment consent does not remove the patient's right to refuse a particular intervention later.
60. Seeing credentials and understanding fees
Maryland gives patients a way to see that a treating professional is currently licensed, but the method depends on the setting. A licensee in an office displays the license conspicuously where patients can see it. For an initial visit outside the office, other than in a hospital or related institution, the licensee presents the wallet-sized renewal card as evidence of current licensure. A hospital or related institution instead displays a notice in the physical therapy reception area explaining that current licensure evidence is on file and available for patient review on request. These are setting-specific duties, so identify where care occurs before choosing the proof. Maryland's code of ethics also requires a PT to provide fee information when a patient requests it. Clear credentials and fee information let patients make informed choices about care.
Worked example: At a patient's first home visit, a PT presents the wallet-sized renewal card and answers the patient's request for fee information before treatment. In the PT's office, the license is displayed conspicuously instead. If the visit occurs in a hospital therapy department, the department displays a notice that current licensure evidence is on file and available to patients on request.
Watch the distinction: An office wall display does not replace presenting the renewal card at an initial home visit. Hospitals and related institutions have a separate notice and review method.
Official references and further reading
- FSBPT current Maryland JAM format and scope
- FSBPT currently linked Maryland JAM complete content outline
- FSBPT current Maryland JAM legal reference: complete laws, rules and selected policy text