A New Hampshire physical therapy decision often turns on three questions: who is acting, what authority they hold, and where the patient is located. A licensed PT manages the patient’s physical therapy care; a PTA assists with selected interventions; a student practices within a specific supervision exception; and an aide performs designated routine tasks under close supervision. Those distinctions affect evaluation, documentation, delegation and remote care. Licensing decisions require similar care: an application, a timely renewal, a reinstated license and a compact privilege do not grant identical authority. This guide follows those decisions into everyday practice, then examines misconduct, complaint procedures and consumer rights. The examples use concrete facts so you can identify the controlling rule and its practical result.
Board Powers and Duties
1. Who regulates physical therapy
New Hampshire divides physical therapy regulation between a profession-specific governing board and the Office of Professional Licensure and Certification (OPLC). The board interprets and enforces the Physical Therapy Practice Act and develops standards for PT and PTA practice within its statutory authority. OPLC supplies shared administration: it processes applications against objective board standards, maintains records, coordinates rulemaking and investigates misconduct allegations. A licensing decision may therefore arrive from OPLC without making OPLC the author of the profession’s scope. When a question concerns what a PT may do, start with the practice act and authorized board rules. When it concerns where an application goes or who investigates a complaint, identify OPLC’s administrative role. The New Hampshire legal reference brings those provisions together for study.
Worked example: A clinic manager sees that OPLC processed a new PT’s application and concludes that OPLC decides whether PTs may perform a particular intervention. Processing the application establishes who handled the licensing transaction. The intervention question requires the practice act and applicable board rules. OPLC applies profession-specific standards when handling applications and investigations; its processing role does not independently create PT scope.
Watch the distinction: It is tempting to treat the agency that sends a license as the source of every practice rule. Administrative processing and profession-specific regulatory authority are related but distinct functions.
2. Board authority and limits
The board’s powers begin with legislation. New Hampshire directs it to provide for PT and PTA examinations, adopt passing scores, and regulate physical therapy by interpreting and enforcing the practice act. It may adopt rules on subjects the statutes authorize, including education standards, examinations, selected interventions and supervision. Rulemaking must follow the state administrative rulemaking process; a proposal, meeting comment or informal answer does not carry the force of an adopted rule. For a disputed requirement, ask three questions in order: Does a statute authorize the board to address this subject? Has an applicable rule been adopted through the required process? What does the effective text actually require? This sequence separates a binding requirement from a useful explanation of one. It also prevents an outdated provision or an individual board member’s view from becoming a supposed legal obligation.
Worked example: At a meeting, a board member suggests that every licensed PTA visit should require the PT to remain in the building. The practice act gives the board authority to regulate supervision, but the suggestion alone changes nothing. The board would need to use its authorized rulemaking process. Until an applicable rule takes effect, the existing New Hampshire supervision requirements govern.
Watch the distinction: A board member’s professional judgment may be persuasive, but it is not automatically a rule. Legal effect depends on statutory authority and the required adoption process.
3. Professional and public representation
The New Hampshire physical therapy governing board has five members: two licensed PTs, one PTA and two public members. This composition brings experience with PT evaluation and patient management, knowledge of the PTA’s selected-intervention role, and perspectives from outside the profession. Public members help keep consumer access, safety and understandable rules in view when professional standards are discussed. Their presence does not change the legal duties of a PT or PTA, and membership alone does not let a person rewrite a statute. In a scenario about board composition, count the seats by role rather than treating every professional seat as a PT seat: two PT plus one PTA plus two public equals five. In a scenario about authority, remember that the board acts as a governing body under statute and rulemaking procedures, not through a single member’s opinion.
Worked example: A candidate says all five board members must be physical therapists because the board regulates PT practice. The stated composition disproves that: two seats are for licensed PTs, one for a PTA and two for public members. The professional members total three, and the public members total two. Five seats do not mean five PT votes.
Watch the distinction: Assuming only PTs can serve overlooks the PTA and public seats. The board’s mixed membership is a deliberate part of New Hampshire’s regulatory structure.
Licensure and Examination
4. Domestic PT and PTA eligibility
Initial eligibility follows the license sought. A domestic PT graduate needs an approved professional PT education program and the board-approved national PT examination. A domestic PTA graduate needs an approved PTA education program and the national examination for PTA practice. Passing one examination cannot establish eligibility for the other license because their education and practice roles differ. New Hampshire also requires initial applicants to show continuing competency in physical therapy during the year before filing; the current rule defines this as at least 24 hours of qualifying activity in that period. A graduate should therefore check the education route, the matching examination and the recent competence record as separate elements. Passing the examination establishes tested entry-level knowledge, while the competence record addresses recent engagement. Neither replaces the remaining application and licensing requirements.
Worked example: A PTA graduate passed the NPTE-PTA and documented 18 qualifying hours in the year before filing. The PTA examination fits the license sought, but the initial competence requirement is 24 hours. The shortfall is 24 minus 18, or 6 qualifying hours. The applicant needs to satisfy that requirement; passing the PTA examination does not confer PT eligibility.
Watch the distinction: Do not combine PT and PTA credentials as though they were interchangeable. Each license has its own education and examination path, and the recent competence requirement is a separate check.
5. Foreign education review
For education completed outside the United States, a diploma identifies a credential but does not by itself establish that the program meets New Hampshire’s educational standard. The review first asks whether the sponsoring institution is recognized by the education ministry where it is located. It then asks whether an acceptable credentials evaluator determines the education to be substantially equivalent to an approved program. The legal reference names the Foreign Credentialing Commission on Physical Therapy and describes conditions under which another evaluator can qualify. The evaluation examines coursework against the specified comparison method; a translation merely makes records readable. Keep this educational finding separate from English proficiency, the applicable national examination, the JAM and the rest of the application. A favorable finding on one element does not settle the others. The role sought, PT or PTA, must also match the education being evaluated.
Worked example: An overseas PT sends a diploma and an accurate English translation of the transcript. The documents show what the school awarded and what courses appear on the record. They do not establish ministry recognition or the required substantial-equivalence finding. The applicant needs a qualifying credentials evaluation before those educational conditions can be treated as met.
Watch the distinction: A translated transcript is evidence for an evaluation, not the evaluation itself. Readability of a record and equivalence of professional preparation answer different questions.
6. English proficiency conditions
New Hampshire’s listed English testing condition applies to an initial PT or PTA applicant whose native language is not English and whose education was outside the United States in a program not approved by CAPTE. Check those conditions before examining scores; foreign education alone does not answer the testing question. For a TOEFL iBT taken under the rule’s later testing route, the required overall score is 89, with writing 22, speaking 24, reading 22 and listening 21. This is a joint test: the applicant must meet the overall result and each listed component. A strong result in one skill does not offset a deficient component. Read a score report by marking every condition separately, then decide whether the full set is satisfied. Educational equivalence and English proficiency remain distinct licensing findings.
Worked example: A non-native English speaker educated in a non-CAPTE foreign program reports TOEFL iBT scores of 91 overall, writing 23, speaking 23, reading 23 and listening 22. The overall score exceeds 89, and three components meet their minimums. Speaking is 23, one point below 24. The listed results therefore do not satisfy the rule.
Watch the distinction: An overall passing score can conceal a component shortfall. When the rule lists both kinds of minimum, adding extra points elsewhere does not repair the deficient skill.
7. National examination retakes
The national PT and PTA examinations have a retake sequence distinct from the JAM. Under the New Hampshire practice act, an applicant who fails the first national examination attempt may make three additional attempts. Count the first attempt before interpreting the retake language: the ordinary sequence covers four attempts in all. To seek another attempt after that sequence, the applicant must complete a new licensure application, except for proof of passing, and submit a plan for additional clinical training, coursework or both that the board approves. Registering again with the testing organization does not replace that New Hampshire condition. This rule addresses the national competence examination, not the law assessment; the JAM rule permits retakes until a passing score is achieved. Distinguishing the assessments prevents an incorrect limit from being applied to the wrong test.
Worked example: An applicant fails the national examination on attempt 1 and then fails three additional attempts, numbered 2, 3 and 4. Those are four attempts total. Before a proposed fifth attempt, the applicant needs a new application and board approval of an additional clinical training or coursework plan. Merely booking another test date does not complete those steps.
Watch the distinction: The phrase “three additional times” means three after the first attempt, not three total. It also concerns the national examination rather than the NH JAM.
8. Completing an initial application
Initial licensure is a completed decision process, not a collection of passing scores alone. New Hampshire applicants take the national examination for the license sought and pass the state jurisprudence assessment. The application then brings together the universal form, profession-specific addendum, education and competence information, fee, and required criminal history materials. The criminal history process includes a release and fingerprints under the allied health statute. OPLC reviews application material under the applicable standards before the person receives authority to practice. A useful decision sequence is: identify PT or PTA, verify the corresponding education and examination, establish the JAM and recent competence requirements, submit the required materials, and confirm issuance or another valid authorization before providing services. The NPTE study guide addresses clinical examination preparation; that examination serves a different purpose from New Hampshire licensure review.
Worked example: A PT applicant has passed the NPTE-PT and NH JAM but has not submitted the required application materials or criminal history release. Two assessment results are complete, yet the licensing file is not. The applicant cannot treat the scores as a New Hampshire license and must wait for issued authority, or another authorization that actually applies, before practicing.
Watch the distinction: A passing score is evidence of one requirement, not permission to practice. Licensing also depends on the application, required review and an issued or otherwise valid authorization.
9. The initial and reinstatement JAM
The New Hampshire Jurisprudence Assessment Module tests knowledge of the jurisdiction’s physical therapy laws and rules. Initial PT and PTA applicants must pass it, and the New Hampshire rule also requires it for applicants seeking reinstatement. It is separate from the national examinations, which test PT entry-level competence or the PTA’s technical knowledge and skills. That distinction matters when reading an application checklist: passing the NPTE does not establish knowledge of New Hampshire supervision, renewal or consumer-rights provisions. The JAM is an individual, open-book assessment on a secure site, with a passing score specified in the state rule. Its New Hampshire JAM page identifies the current online format. For preparation, use the state-specific physical therapy jurisprudence guide to connect each legal topic to a practical decision rather than memorizing a list of agencies or assessment names.
Worked example: A PTA applicant presents a passing NPTE-PTA score and asks to omit the NH JAM. The NPTE-PTA supports the national technical examination requirement. The JAM addresses New Hampshire jurisprudence, so the NPTE-PTA result does not fulfill it. The applicant must pass the JAM and complete the other applicable licensing requirements before treating the application as complete.
Watch the distinction: Both assessments involve physical therapy, but they test different things. National technical competence does not substitute for the state law assessment required of a PTA applicant.
10. PT student and visitor exceptions
A person who has not obtained a New Hampshire PT license can provide care only if a specific authorization or exemption fits the activity. The PT student exception covers supervised clinical education in an approved professional program while the student is under on-site supervision by a licensed PT. Its purpose is education within a defined placement, not staffing an independent practice. Other exemptions address limited situations, including specified teaching or seminar activity and service to affiliated members of visiting athletic or performing arts groups. Those exceptions depend on who the visitor is, what activity is occurring and the limits in the statute. Apply an exception by matching every condition to the facts; do not transfer one person’s exception to another. An unrelated visitor providing routine continuing care needs an applicable New Hampshire authorization rather than a broad claim that visitors may practice.
Worked example: A PT student performs clinical work for an approved program while a licensed PT supervises on-site. Those facts fit the student education exception. A visiting PT from another jurisdiction then offers weekly treatment to local patients indefinitely. The student exception cannot cover that visitor, and the limited teaching or visiting-team exceptions do not describe routine ongoing local care.
Watch the distinction: An exemption is tied to a named person and activity. A clinic cannot use a legitimate student placement to justify unrelated ongoing services by an unlicensed visitor.
11. PTA student supervision
A PTA student’s clinical education exception requires direct supervision by a PT. New Hampshire defines direct supervision through the PT’s physical presence and immediate availability, with direct patient contact during each visit as defined in the statute. Telephone availability cannot satisfy that level. A PT student’s exception uses on-site PT supervision, while a licensed PTA ordinarily works under general supervision, which permits an off-site PT who is available at least by telecommunications. These categories should be applied to the person’s current status, not to the kind of treatment being performed. Before assigning a visit, identify whether the worker is a PTA student or a licensed PTA, then apply the corresponding supervision condition. A student’s progress in training does not itself convert the student into licensed staff or reduce the required supervision.
Worked example: A PTA student is scheduled to perform an assigned patient intervention while the PT works at another clinic and remains reachable by phone. The PT is available remotely but is neither physically present nor immediately available in person. That fails the direct-supervision condition for the student exception. The visit must be rescheduled or staffed with the required PT supervision.
Watch the distinction: General supervision may suffice for ordinary work by a licensed PTA, but the PTA student exception specifies direct supervision. The worker’s legal status controls the distinction.
12. Endorsement and temporary authority
An active license from another jurisdiction can support a New Hampshire licensing route, but it does not automatically authorize practice in New Hampshire. Under endorsement, OPLC considers evidence of good standing and whether the other jurisdiction’s licensing requirements are substantially similar, with the required criminal history review where applicable. The result sought is a New Hampshire license. A temporary-license route instead gives a time-limited New Hampshire authorization under its own application conditions while full licensure is pursued. Its limits and continuation rules must be read as part of that authorization. In a case question, separate evidence from permission: an out-of-state license is evidence relevant to eligibility; an issued New Hampshire license, valid temporary license or other applicable authority permits practice. Do not confuse either route with the compact privilege, which has different eligibility conditions and is tied to a remote state.
Worked example: A PT licensed in good standing elsewhere submits a New Hampshire application and asks to begin treating patients immediately. The existing license is relevant to endorsement and may support a temporary-license application. Filing for either route alone does not issue New Hampshire authority. The PT can start only when an applicable full, temporary or other valid authorization is in place.
Watch the distinction: Good standing elsewhere is an eligibility fact, not a portable New Hampshire license by itself. Confirm the particular authorization granted before scheduling patient care.
13. Compact privilege and patient location
Under the Physical Therapy Compact, practice occurs where the patient is physically located during the encounter. The home state is the licensee’s primary state of residence; New Hampshire is the remote state when the patient is here and the practitioner relies on a compact privilege. A valid home-state license alone does not create that privilege. The compact requires eligibility conditions, notice to the commission, applicable fees and the remote state’s jurisprudence requirement. FSBPT states that an applicant for an initial New Hampshire compact privilege must pass the NH JAM before purchasing it. Once privileged, the PT or PTA follows New Hampshire practice standards for encounters here and remains subject to New Hampshire regulatory authority. For a remote visit, identify the patient’s location first, then the professional’s authorization for that location, then the applicable scope and supervision rules.
Worked example: A PT lives and holds an unencumbered license in a compact home state. The PT plans a video session while the patient sits in New Hampshire. The patient’s location makes this New Hampshire practice. Before the encounter, the PT must meet compact eligibility conditions, pass the NH JAM and obtain the New Hampshire compact privilege; the home license alone is insufficient.
Watch the distinction: A video call does not relocate the patient to the PT’s state. Under the compact, the patient’s physical location determines the remote practice jurisdiction.
14. Timely renewal versus lapse
A timely, complete renewal application by an eligible licensee preserves the existing license’s validity while OPLC acts on it. Completeness is central: New Hampshire requires the completed application, fee and supporting documents by expiration. If those elements have not been filed by then, the license lapses, and the holder is not authorized to practice until reinstatement. A saved draft, an unpaid form or an assumption that reminder mail will arrive does not meet the filing condition. Examine a renewal scenario in this order: Was the applicant eligible? Were all required items submitted? Did receipt occur by expiration? If so, validity continues pending action; if not, identify the lapse and use the reinstatement route. This framework distinguishes an administrative processing delay after a complete filing from a gap caused by an incomplete filing.
Worked example: Two PTAs have licenses expiring Friday. PTA A submits the completed application, fee and required records on Thursday and is eligible; the license continues while OPLC acts. PTA B submits only the form on Thursday and sends the fee after expiration. B did not meet the complete-renewal condition, so the license lapses and practice must stop until reinstatement.
Watch the distinction: Timeliness of a partial filing is not the same as timely renewal. The continuation rule requires a complete submission from an eligible licensee.
15. Continuing competence balance
For renewal, New Hampshire requires PTs and PTAs to complete 24 contact hours of continuing competence in each two-year cycle. At least half must relate directly and primarily to clinical application of physical therapy, so the minimum clinical share is 24 ÷ 2 = 12 contact hours. Other qualifying hours can address general practice topics such as supervision or consultation. Classify an activity by its primary content rather than its title or the fact that a PT attended it. Then total eligible hours and test the clinical subtotal separately. Extra general-practice hours do not repair a clinical deficit. If the record contains exactly 24 hours, meeting the clinical minimum means the mix must include at least 12 clinical hours. A new clinical hour added without replacing a general hour changes both the total and the half-of-total calculation.
Worked example: A PT has 11 clinical and 13 general-practice contact hours: 11 + 13 = 24. Half of the required 24 is 12 clinical hours, so the clinical subtotal is one hour short. Replacing one general hour with one eligible clinical hour gives 12 clinical + 12 general = 24 and meets the mix. If instead adding hours, two clinical hours yield 13 of 26, exactly half.
Watch the distinction: Twenty-four total hours are insufficient when the clinical share is short. Also, adding one hour changes the total, so calculate the clinical proportion again.
16. Crediting different learning activities
Different learning activities use different credit conversions. Eligible academic coursework beyond initial licensure receives five contact hours per academic credit hour. Successful attendance at an eligible nonacademic seminar or workshop receives one contact hour per clock hour. These conversions produce a preliminary subtotal; the activity still needs to qualify, fit the renewal cycle and be classified as clinical or general practice. Some categories have their own caps. For example, qualifying short facility in-service training receives one contact hour per clock hour but is limited to eight contact hours per renewal cycle. Apply a cap to the activity category before adding that category to the overall record. This prevents a long series of short sessions from appearing to satisfy the entire renewal requirement. Keep the supporting transcript, certificate or other specified proof with the calculation.
Worked example: A licensee successfully completes a qualifying two-credit academic course and attends a qualifying three-clock-hour seminar. The course earns 2 × 5 = 10 contact hours; the seminar earns 3 × 1 = 3. Together they provide 13 eligible contact hours before clinical classification. If the licensee also completed 10 eligible hours of short facility in-services, only 8 of those hours count under that category’s cycle cap.
Watch the distinction: Clock hours and academic credits do not use the same conversion. Convert each activity under its own rule, apply any category cap, then check the clinical share.
17. Evidence for a competence audit
A continuing-competence claim must be traceable to evidence of actual completion. New Hampshire’s audit process asks a selected renewal applicant to report activities and furnish the proof specified for each activity type. For a nonacademic workshop, the rule describes an official certificate showing the attendee, program, provider, dates, credited hours and an appropriate signature or stamp. Academic work uses a transcript plus a course description or syllabus. Other activities have their own proof, such as a supervisor’s memo for qualifying in-service training. The reasoning sequence is activity, credit rule, amount claimed and required evidence. An invitation establishes that an event was offered, while a registration receipt establishes payment; neither alone establishes attendance or successful completion. If evidence is missing, the claimed hours may fail audit review even when the learning occurred.
Worked example: A PTA lists a four-hour workshop for renewal and retains only a calendar invitation. The invitation identifies a planned event but does not show that the PTA attended or earned four contact hours. The PTA should obtain the required certificate or other rule-compliant completion evidence. Until then, the four hours are unsupported for an audit.
Watch the distinction: A calendar entry or payment receipt can help reconstruct a record, but it is not the specified proof of completed learning and credited hours.
18. Periodic JAM obligation
Current New Hampshire PT and PTA licensees must take and pass the NH JAM in years ending in 0 or 5. The state renewal rule specifies April, May or June for that periodic assessment. If a licensee does not take it or does not pass during the required period, the rule calls for notice to OPLC within 30 days and a dated, signed written request to take it in a future month. That request must explain the failure and provide a plan for complying in future required periods. A later passing score does not erase the separate duty to report the missed period. Distinguish this periodic obligation from the JAM required for initial licensure, reinstatement and an initial New Hampshire compact privilege. The NH JAM practice questions can help rehearse application of the law; they do not replace the required assessment.
Worked example: A licensed PT fails to complete the JAM during April through June of a year ending in 5. The PT should notify OPLC within 30 days and submit a signed, dated request explaining the lapse and proposing how to complete the assessment in a future month. OPLC then addresses the request under the rule; simply waiting for the next five-year period leaves the missed obligation unresolved.
Watch the distinction: The periodic JAM is not satisfied by having passed it at initial licensure. A missed required period also triggers a response separate from eventual completion.
19. Reinstatement after a short lapse
Once a New Hampshire PT or PTA license lapses, renewal is no longer the route and practice must stop until reinstatement. For a lapse of no more than 90 days, the rule provides a full-reinstatement path with a completed application, fee, work history, proof of any unfinished continuing competence, the required JAM and other specified materials. A particularly important item is the written statement that the applicant has not practiced physical therapy in New Hampshire, paid or volunteer, since the license ceased to be valid. That statement addresses the period without authority; unpaid care is still practice for this purpose. Count elapsed days from the lapse, then use the short-lapse requirements if the period fits. Submission of the reinstatement packet starts the review but does not itself restore practice authority. Confirmation of reinstatement is the operative point for returning to work.
Worked example: A PT’s license lapsed 35 days ago, and the PT has provided no paid or volunteer PT care since expiration. Thirty-five days falls within the no-more-than-90-day route. The PT submits the required reinstatement materials, including the truthful no-practice statement, and remains out of PT practice while OPLC processes the application. Practice resumes only after reinstatement is granted.
Watch the distinction: Volunteer treatment still counts as physical therapy practice during a lapse. A short lapse makes a reinstatement route available; it does not preserve the expired license.
20. Long lapses and professional activity
For a lapse longer than 90 days, New Hampshire distinguishes applicants by lapse duration and recent professional activity. A license lapsed no more than four years may be considered under the specified full-reinstatement route. If the lapse exceeds four years, that route can still apply when the applicant has been active in the profession during the preceding four years and meets the other requirements. The rule’s definition of active professional work includes qualifying clinical practice, education, administration, consultation, research or full-time advanced PT study, with an hours test tied to the preceding 24 months. A long-lapsed applicant lacking the required activity is directed toward conditional reinstatement and supervised return to practice. The applicant should therefore establish dates and documented activity before choosing a route. A work-history label alone is weaker than records showing what work occurred, when and for how long.
Worked example: A PTA’s New Hampshire license lapsed more than four years ago. The PTA documents qualifying professional activity throughout the preceding four years, including records sufficient to assess the rule’s activity and hours definition. That evidence supports consideration under the full-reinstatement route. The PTA must still satisfy its application, character, supporting-material and JAM requirements and cannot practice on the lapsed license.
Watch the distinction: A lapse exceeding four years does not automatically require conditional reinstatement. Recent qualifying professional activity can support the full route, but it does not itself reinstate the license.
21. Supervised return to practice
Conditional reinstatement lets a PT or PTA return after a period without qualifying professional activity while supervised practice tests readiness for full authority. The New Hampshire rules require 320 supervised hours, with the supervision mix tied to the length of inactivity. For the four-to-six-year category, the first 200 hours each week require at least 50% direct personal supervision and 40% direct supervision, leaving no more than 10% under general supervision. The following 120 hours use a different mix: at least 30% direct personal, at least 30% direct, and no more than 40% general. Apply each percentage to hours worked in that week, not just to the 320-hour total. Direct personal supervision is continuous, in-person observation and direction; direct supervision still requires the PT's physical presence. Full reinstatement also requires completion of the practice period and a supervisor's approval of readiness. The New Hampshire legal reference sets out these stages.
Worked example: Assume a conditionally reinstated licensee in the four-to-six-year inactivity category works 20 hours in one week within the first 200 supervised hours. Direct personal supervision must cover at least 20 × 50% = 10 hours; direct supervision, at least 20 × 40% = 8 hours; and general supervision, no more than 20 × 10% = 2 hours. A 10/8/2 schedule totals 20 hours and meets all three limits.
Watch the distinction: It is tempting to average supervision across the full 320 hours. The rule applies its percentages to each week's hours and changes the required mix after the first 200 hours.
Patient Care Management
22. The PT’s evaluative role
The PT manages the patient's physical therapy care, beginning with examination and evaluation. Examination gathers relevant history, tests and measures; evaluation interprets those findings to identify the movement problem, establish a physical therapy diagnosis and prognosis, and choose an intervention plan. Prognosis addresses expected improvement and the course of care, not a promise of recovery. The plan connects findings to goals, selected interventions and later reassessment. A referral from another practitioner may provide useful medical information, but it does not perform the PT's evaluation. A licensed PTA assists with selected components of intervention under PT supervision and reports a status change that may require a plan change. The distinction also helps separate New Hampshire practice law from the clinical knowledge assessed in the National Physical Therapy Examination guide: competence to carry out treatment does not transfer the PT's care-management responsibility to the PTA.
Worked example: A new patient arrives with a referral for gait difficulty, and a PTA has an open appointment. The PTA may help gather information within an assigned role, but cannot independently turn the referral into a physical therapy diagnosis or establish the first plan. The PT examines the patient, interprets the gait findings, records the initial evaluation and sets the plan. The PTA can then provide selected interventions under supervision.
Watch the distinction: A referral does not replace the PT's evaluation. It may identify a medical concern or requested service, but the PT still determines the physical therapy findings and plan.
23. Scope boundaries for interventions
New Hampshire defines physical therapy broadly through its purposes and permitted types of care. A PT may examine movement-related conditions, design and modify interventions, and assess outcomes. The statutory examples include therapeutic exercise, manual therapy, movement training, airway clearance techniques, integumentary protection and repair, debridement and wound care, modalities, equipment, and patient instruction. Listing an intervention in scope does not mean it is appropriate for every patient: the PT must still have the skill, clinical reason and safety conditions to use it. The practice act also draws explicit boundaries. Physical therapy authority does not confer authority to practice medicine or another healing profession. It excludes use of roentgen rays and radium for diagnostic or therapeutic purposes and electricity for surgical purposes, including cauterization. When classifying a proposed service, first identify what the practitioner will actually do, then test both the scope definition and any express exclusion.
Worked example: A PT plans therapeutic exercise to improve walking and wound care for a movement-related treatment need. Those intervention types appear in the New Hampshire scope definition, subject to competence and patient safety. The PT then proposes taking diagnostic X-rays in the clinic. Diagnostic use of roentgen rays is expressly excluded from physical therapy authority, so that part cannot be justified by the otherwise appropriate treatment plan.
Watch the distinction: A broad list of PT interventions does not override an express statutory exclusion. Calling an X-ray part of rehabilitation does not make diagnostic radiography a PT service.
24. Initial written evaluation
The PT must provide an initial written evaluation for each patient. Its function is to show how examination findings led to a physical therapy assessment and care plan. Useful content connects the patient's concern and relevant history to observed impairments, movement limits, safety considerations, goals and the interventions selected. A list of exercises records activity, but cannot show why that activity was chosen or whether it fits the patient's condition. The evaluation also creates a baseline for later written reevaluations: a change can be interpreted only if the earlier status and intended outcomes are clear. The PT remains responsible for managing all aspects of care, including oversight of records made by others. A PTA's treatment note can accurately describe care delivered, yet it does not become the PT's initial evaluation merely because it appears in the same chart or on the first date of service.
Worked example: On a first visit, the chart says the patient completed three balance exercises and needed two pauses. It contains no PT examination findings, interpretation, goals or plan. The entry describes treatment but does not satisfy the PT's initial written evaluation duty. The PT must assess and document the patient's starting status, explain the treatment rationale and establish the plan before treating the exercise note as evidence of an evaluated course of care.
Watch the distinction: A detailed first-day treatment note is still a treatment note. The PT's initial written evaluation must connect findings to the assessment and planned care.
25. Reevaluation and plan changes
The PT provides periodic written reevaluations and remains responsible for deciding whether the plan should change. A reevaluation compares current findings with the earlier baseline and goals, interprets the patient's response, and determines whether the interventions, intensity or expected outcomes remain suitable. A fixed appointment pattern cannot substitute for that clinical judgment. A PTA may observe performance, record measurements and assess the effect of a selected intervention, but must report a patient status that requires a change in the plan. When a new finding raises an immediate safety concern, the PTA should avoid continuing an unsafe activity while communicating with the PT. The PT then examines the significance of the finding and records the reevaluation and any revised plan. This sequence preserves the PTA's useful day-to-day observations without assigning the PTA the PT's responsibility to redesign care.
Worked example: During three gait-training visits, a patient who previously walked steadily loses balance twice despite using the planned device. The PTA stops the unsafe portion, documents when the losses occurred and reports them to the PT. The PT reevaluates balance, reviews whether the goal and intervention remain suitable, and records a plan change if warranted. Simply repeating the original program would leave the new findings unexplained.
Watch the distinction: A PTA's observation may reveal the need for a new plan, but observing the change does not give the PTA authority to independently establish that plan.
26. Discharge responsibilities
At discharge, New Hampshire assigns the PT a written discharge plan and documentation of the patient's response to treatment. This closes the reasoning loop that began with the initial evaluation: what was attempted, how the patient responded, which goals were met or remain limited, and what the patient should do next. A sound discharge plan can address continuing exercises, safety needs, follow-up or referral when appropriate to the individual case. It should reflect actual findings rather than merely the fact that visits ended. A PTA remains responsible for documenting the care provided during a final visit, including the patient's immediate response, but that routine entry does not replace the PT's discharge work. The PT's ongoing responsibility for the record means the discharge account should agree with the documented course of treatment and give the next provider or patient a usable picture of the outcome.
Worked example: At the final scheduled appointment, a PTA records 15 minutes of gait training, the exercises performed and the patient's tolerance. Those facts support the visit record. The PT still assesses progress against the plan, documents the patient's response over the course of care and provides a written discharge plan. If walking remains limited, the plan should explain the remaining limitation and appropriate next steps, rather than state only that visits are complete.
Watch the distinction: The last treatment note does not automatically discharge the patient. New Hampshire separately requires the PT's written discharge plan and account of treatment response.
27. Selected PTA interventions
A licensed PTA assists a PT with selected components of physical therapy intervention. The PT establishes and manages the plan, decides which services require PT expertise, and determines whether the PTA's assignment is safe and effective for this patient. Within that assignment, the PTA can deliver care, observe the response and document what occurred. A new symptom can change the risk of carrying out even a familiar intervention. The PTA should respond to the immediate safety issue, record the finding and report a status that may require a plan change to the supervising PT. The PT decides whether to reevaluate and modify the plan. Think of the division as implementation plus timely feedback by the PTA, with evaluative and plan decisions retained by the PT. Supervision does not make an otherwise unauthorized independent PTA decision permissible.
Worked example: A PTA begins gait training under the PT's established plan. The patient then reports new dizziness and sways when standing. Continuing the planned walking distance would be unsafe, so the PTA stops that activity, helps the patient to safety, documents the symptom and contacts the PT. The PT evaluates its significance and decides whether the gait plan can continue, needs modification or requires referral.
Watch the distinction: Following a PT plan does not require the PTA to continue an unsafe activity. Stopping and reporting a new finding is different from independently rewriting the plan.
28. General supervision of a PTA
New Hampshire defines general supervision by the PT's availability rather than physical presence: the PT need not be on-site but must be available at least by telecommunications. This is the ordinary supervision level specified for a licensed PTA. Availability should be real enough for the PTA to obtain direction when a patient's status raises a question. The PT still manages care, assigns selected interventions and receives reports of status changes requiring a plan decision. Do not transfer this definition to another role or task. Direct supervision requires the PT to be physically present and immediately available, with direct patient contact during each visit as defined in the statute. Direct personal supervision requires continuous, immediate in-person direction by a PT or PTA. A PTA student has a direct-supervision condition, while an aide's routine tasks require direct personal supervision. Identify the person's status before choosing the applicable supervision level.
Worked example: A licensed PTA performs an assigned intervention while the PT works at another clinic and is reachable by phone. If the PT can provide direction and the assignment is appropriate, being off-site can satisfy general supervision. If the worker were a PTA student, phone access alone would fail the student exception because direct supervision requires the PT's physical presence and availability.
Watch the distinction: General supervision permits an off-site PT; it does not mean no supervision. Phone availability also cannot satisfy a rule that requires direct or direct personal supervision.
29. PTA notes and PT review
The PTA must document care delivered and tell the supervising PT about a patient status that may require a change in the plan. A useful treatment note identifies the intervention, relevant observations and the patient's response so the PT can evaluate progress and safety. New Hampshire adds a specific oversight step: the supervising PT reviews and co-signs all notes during each reevaluation. That review lets the PT compare the PTA's observations across visits with the evaluation and decide whether the plan still fits. Co-signature is part of oversight, not a transfer of authorship. The PTA remains responsible for an accurate account of the care the PTA provided, while the PT remains responsible for overall patient care management and reevaluation. Read the notes for changes and trends, not merely for whether a signature field has been filled.
Worked example: Across four visits, a PTA documents gait distance, assistance needed and episodes of fatigue. At the PT's reevaluation, the PT reviews and co-signs those notes, compares the pattern with the original goals and documents the patient's current status. If assistance has increased, the PT decides whether to alter the plan. The PTA's notes supply evidence, but neither their detail nor the PT's co-signature substitutes for the reevaluation.
Watch the distinction: Co-signing is not a way to turn PTA notes into a PT reevaluation. The PT must review the information and make the care-management decision.
30. Aides and direct personal supervision
An aide is a trained support person who performs designated, supervised routine tasks related to physical therapy. The PT must document the aide's education and training for the specific assigned tasks, then decide whether using the aide is safe, effective and efficient for the patient. The aide does not independently examine, diagnose, establish a plan or make patient-specific treatment decisions. New Hampshire requires direct personal supervision by a PT or PTA for aide work. The supervisor must be physically present and immediately available, with direction and supervision continuous while the tasks are performed; telecommunications cannot meet that definition. Distinguish this from general supervision of a licensed PTA, who has a different role and training. A task that was routine yesterday may cease to be suitable for an aide if the patient's condition changes or the supervisor can no longer provide the required attention.
Worked example: An aide has documented training to prepare equipment for a routine intervention. A PTA starts supervising the setup, then leaves the area to treat another patient while the aide continues alone. The required continuous direct personal supervision is absent. The aide must pause until a PT or PTA can supervise the task as required, or an authorized clinician must handle it. Prior training does not remove the supervision condition.
Watch the distinction: Documented aide training is necessary for assigned tasks, but it does not make the aide independently authorized or replace continuous direct personal supervision.
31. Student care is supervised care
New Hampshire's student exceptions permit specified clinical education, not independent staff practice. A PT student pursuing an approved professional degree may perform supervised clinical education requirements under on-site supervision of a licensed PT. A PTA student in an approved program may carry out the relevant clinical education under direct supervision of a PT. Direct supervision requires the PT's physical presence and immediate availability, including direct contact with the patient during each visit; a phone call does not satisfy it. These conditions attach to the educational activity and role, so the clinic must schedule qualified supervision when it schedules student care. Students also have ethical responsibilities during clinical training under the current APTA Code of Ethics, which covers PTs, PTAs and students under guidance. The association code guides conduct; the New Hampshire exception determines legal authority.
Worked example: A clinic puts a PT student on the evening schedule as the only clinician for a new-patient evaluation. The student is in an approved program, but no licensed PT will be on-site. The clinical education exception therefore does not cover the appointment as arranged. The clinic must have the licensed PT supervise on-site or reschedule the evaluation for a properly supervised session. The student's progress in training does not create a license.
Watch the distinction: Being enrolled in a PT or PTA program is only one condition. The clinical education exception also requires the specified supervision while the student provides care.
32. Choosing whether to delegate
Delegation is a patient-specific decision, not a permanent property of a task. The PT first decides whether the intervention requires PT expertise. For a task that can be assigned, consider its complexity, the patient's current condition and likely response, the worker's documented training and role, and whether the required supervision will actually be available. An aide may perform designated routine tasks under direct personal supervision; a licensed PTA may perform selected interventions under PT general supervision. Neither role acquires the PT's responsibility for evaluating the patient or changing the plan. Reassess an assignment when symptoms, balance, cognition or other conditions make the response less predictable. Documented qualifications show that someone learned a task, but they cannot establish that the task remains safe for this patient today. The PT remains responsible for managing all aspects of care and for the decision to use assistive personnel.
Worked example: An aide previously prepared a routine exercise station for a patient who followed instructions reliably. Today the patient becomes confused and repeatedly tries to stand without assistance. The PT reassesses the assignment: equipment setup may remain routine, but monitoring the patient's changing behavior calls for clinical judgment and immediate safety action. The PT assigns an appropriate clinician and ensures any remaining aide task has direct personal supervision.
Watch the distinction: A task's routine label does not make every patient encounter routine. Delegation must fit the patient's current status and the worker's role and supervision.
33. Referral beyond PT scope
A PT must refer a patient to an appropriate health care practitioner when there is reasonable cause to believe symptoms or conditions require services beyond physical therapy scope. This is a decision about the limits of the service, not a demand that the PT name a medical diagnosis. Examine the history and findings, identify what is unexplained or beyond movement-focused care, and judge whether proceeding with PT would delay needed assessment. The PT can still communicate useful examination findings and the reason for referral. The urgency of the response depends on the presentation and safety risk, rather than a single universal pathway. If physical therapy itself is contraindicated, referral is also required. A PTA who encounters a concerning change should protect the patient and report it to the PT, who holds the care-management and referral responsibility. Accurate documentation makes the clinical reasoning and communication clear.
Worked example: During a PT evaluation for shoulder stiffness, a patient reports new unexplained symptoms that do not fit the movement findings and may need medical assessment. The PT records the relevant history and findings, explains why physical therapy alone cannot resolve the concern, and arranges referral to an appropriate practitioner. The PT does not need to declare a medical diagnosis before referring, and does not press ahead with the planned treatment as though the new information were irrelevant.
Watch the distinction: Referral beyond PT scope does not require certainty about the underlying disease. Reasonable cause that another service is needed is enough to trigger the referral duty.
34. When PT is contraindicated
A contraindication means physical therapy should not be provided in the circumstances identified; a precaution or poor response may instead call for a narrower change in the intervention plan. The PT must distinguish these possibilities from the patient's findings. First stop or withhold an intervention that appears unsafe. Then assess whether another PT intervention could be suitable, whether more examination is needed, or whether the condition makes PT itself inappropriate. New Hampshire requires referral when physical therapy is contraindicated, as well as when reasonable cause suggests a need for services beyond PT scope. That rule does not authorize a PT to diagnose or treat the outside condition. A PTA who notices a potential contraindication should keep the patient safe and promptly report the finding to the PT. Clear documentation should identify what changed, what care was withheld and why the patient was referred or the plan modified.
Worked example: A patient arrives for a planned exercise session with new findings that make the proposed activity unsafe. The PTA pauses it and alerts the PT. The PT assesses the findings: if a different PT intervention remains appropriate, the PT may revise the plan; if PT itself is contraindicated or another service is needed, the PT withholds PT care and refers the patient. The decision turns on the patient's condition, not the fact that exercise was previously scheduled.
Watch the distinction: Stopping one unsafe exercise does not automatically mean all PT is contraindicated. The PT must decide whether the plan can be adjusted or referral is required.
35. Authority for remote encounters
For a remote encounter, start with where the patient is physically located when care occurs. The Physical Therapy Compact treats practice as occurring in that state, and New Hampshire's telehealth law generally requires an out-of-state professional serving a patient in New Hampshire to hold applicable New Hampshire authority, including a license or compact privilege, unless a statutory exception applies. The provider's home address, clinic address and video platform do not move the patient's location. A compact home-state license alone does not automatically authorize practice in every remote state; the clinician must obtain the remote-state privilege and meet its jurisprudence requirement. New Hampshire's telehealth statute also contains specific exceptions and permission for certain consultation or follow-up care involving a patient previously served in the provider's licensed state, so classify the actual encounter before applying the general rule. Once authorized, the clinician must follow New Hampshire practice standards for the encounter.
Worked example: A PT sits at home in another state and opens a video visit with a patient physically in New Hampshire. This is New Hampshire practice under the compact's location rule. If the PT relies on the compact, the PT needs a New Hampshire compact privilege and must satisfy the applicable New Hampshire requirements before the visit. Having a home-state license or using a video service alone does not supply that authority.
Watch the distinction: Telehealth does not follow the clinician's laptop. Patient location controls the ordinary jurisdictional analysis, subject to the specific exceptions in New Hampshire law.
36. Telehealth care duties
A remote PT encounter must meet the same standard of care as an in-person encounter. The PT should choose methods that can produce dependable findings and safe guidance through the available connection. If camera position, sound, patient assistance or the environment prevents adequate observation, change the assessment method or arrange in-person care. Telehealth does not expand PT scope or change the PT's responsibility for evaluation, the plan, supervision and referral. New Hampshire also requires a medical record for direct telehealth services. When appropriate and with the patient's consent, the provider forwards the record to the primary care or treating provider. Meaningful language access duties apply in the facilities covered by the cited laws. Reason through remote care in this order: authority to serve the patient at that location, clinical suitability of the medium, safe delivery, and accurate documentation of findings, limitations and decisions.
Worked example: A PT asks a patient on video to perform a balance task, but the camera shows only the patient's face and the connection repeatedly freezes. The PT cannot reliably assess sway or guard a fall. The PT stops that task, uses any safer assessment the medium permits or arranges an in-person visit, and records the observations, connection limits and next plan. The visit being remote does not lower the standard of care.
Watch the distinction: A completed video call is not proof that an assessment was adequate. If the medium hides clinically necessary information, the PT must adapt care and document the limitation.
37. Medication-related boundaries
New Hampshire permits a PT to purchase and store topical and aerosol medications for administration upon a prescription from a health care practitioner licensed in the state and legally permitted to prescribe. It also requires compliance with New Hampshire pharmacy board storage rules. This is a narrow authority tied to medication form, an authorized prescription and proper storage; it does not make the PT an independent prescriber. Decide who selected and prescribed the medication before considering how it will be applied during PT care. Then check that the intended use fits the PT intervention and the patient's circumstances. The practice act expressly says PT licensure does not authorize medicine or other listed healing professions beyond physical therapy. A PTA's ability to assist in selected interventions also does not create prescribing authority. Keeping the prescription decision separate from administration avoids treating a practical treatment supply as an unrestricted medication privilege.
Worked example: A PT wants to apply a topical medication during a session and has it in clinic stock, but no practitioner licensed and authorized to prescribe in New Hampshire has prescribed it for this use. The PT cannot rely on the purchase-and-storage provision to choose and administer the medication independently. The PT must first have the required authorized prescription and meet applicable storage rules; holding the product does not establish either condition.
Watch the distinction: Permission to purchase and store a topical or aerosol medication is conditional. It does not authorize the PT to prescribe it or dispense with the required prescription.
38. Ongoing informed consent
Informed consent is an ongoing decision about participation, supported by information the patient can understand. The current APTA Code expects PTs and PTAs to explain what is necessary for the patient or surrogate to make an informed choice and to obtain ongoing consent, particularly when care involves touch. In practice, explain the proposed intervention, its purpose, material burdens or risks, and reasonable alternatives at a level the patient can use. Listen for questions and changes in preference. A patient's agreement to one intervention does not silently authorize every later technique; refusal should shape the care plan rather than be treated as noncompliance to overcome. The PT remains responsible for plan decisions, while a PTA should communicate a refusal or changed preference affecting assigned treatment. Document the discussion and the resulting decision so the record reflects both patient choice and the clinical response.
Worked example: A patient agreed to an exercise program at the initial evaluation. At a later visit, the PT proposes a hands-on technique and the patient declines. The PT explains its purpose and reasonable alternatives, checks that the refusal is understood, and respects it. The PT then chooses an acceptable option or revises the plan, recording the patient's preference and the care decision. The earlier exercise consent does not authorize the declined technique.
Watch the distinction: A signed intake form is not blanket consent for every intervention. Meaningful consent continues through treatment and can change when a patient declines a proposed technique.
39. Confidential communications
New Hampshire places confidential patient communications with PTs and PTAs on the same legal basis as physician-patient communications. The protection also extends to customary, necessary treatment communications with people working under a licensee's supervision. Treat those details as confidential in ordinary practice: share them only through a valid authorization or another legal basis, and avoid casual disclosure in public or unrelated workplace discussion. The privilege has an important boundary. It does not apply to investigations and disciplinary proceedings conducted by New Hampshire agencies regulating health professions. That exception means a licensee cannot categorically refuse a proper regulatory inquiry merely by calling treatment discussions privileged. It does not turn patient information into public material; complaint and investigation records are generally held confidential unless used in disciplinary proceedings. Keep the two questions separate: whether the regulator may obtain relevant information and whether the information may be publicly disclosed.
Worked example: A PT tells a clinic manager that treatment discussions can never be considered in a licensing investigation because they are privileged. The manager should correct that conclusion. New Hampshire's privilege generally protects confidential patient communications, but its health-profession investigation and disciplinary exception applies. Relevant material can be handled through the regulatory process, with the investigation's separate confidentiality protections; the clinic should not publish the patient's discussions simply because an investigation exists.
Watch the distinction: Privilege is not absolute secrecy against the licensing regulator. The statutory investigation exception removes that barrier while separate rules still govern confidentiality of investigative material.
Disciplinary Actions and Unlawful Practice
40. Truthful licensing disclosures
New Hampshire treats knowingly or negligently inaccurate material information to the board or OPLC, and failure to give complete and truthful material information when asked, as misconduct. The rule expressly reaches initial licensure, renewal and reinstatement. Material information is information that could matter to the licensing decision, such as a requested history of disciplinary action or another authorization to practice. The applicant should answer the question asked, supply the relevant facts and correct a discovered error promptly. An omission is not made harmless because a regulator might find the information in another database; the applicant's disclosure duty remains. At the same time, distinguish a material misstatement from an immaterial typo by asking whether the missing or wrong fact bears on eligibility, character, competence or authorized practice. A truthful explanation of an event gives the decision maker the facts needed to apply the licensing standards.
Worked example: An applicant for New Hampshire reinstatement is asked for prior licensing actions and omits a suspension imposed by another state. That action bears directly on the requested license history and could affect the decision, so the application is materially incomplete. The applicant should correct the submission and provide the circumstances rather than assume the board's access to other-state records excuses the omission. The same disclosure principle applies to an initial or renewal application.
Watch the distinction: A licensing form is not truthful merely because every stated sentence is accurate. Leaving out a requested material fact can itself constitute misconduct.
41. Convictions and reporting
New Hampshire treats conviction of a criminal offense other than a traffic violation as professional misconduct for a PT or PTA licensee. The rule also creates a separate duty to report a covered conviction to the board within 30 days. Work through these as two questions: first, does the event meet the rule’s conviction category; second, when was it reported? A pending charge is different from a conviction under this specific provision, although an application may ask broader questions that require truthful answers. The traffic exclusion belongs to this conviction rule; it does not excuse unsafe conduct connected with driving or another violation of professional duties. Record the date of conviction and the date the report was made so the reporting interval is clear. The New Hampshire legal reference contains the governing misconduct rule.
Worked example: A New Hampshire PTA is convicted of a non-traffic criminal offense on April 1 and reports it to the board on May 16. Forty-five days elapsed, exceeding the 30-day reporting period by 15 days. The conviction is itself within the misconduct rule, and the late report raises a separate issue. Reporting eventually does not erase either concern.
Watch the distinction: A common error is to wait until renewal to disclose a conviction. The misconduct rule sets a separate 30-day reporting duty for a covered conviction.
42. Discipline in another jurisdiction
A PT or PTA who holds authority in more than one jurisdiction remains accountable to New Hampshire for conduct relevant to New Hampshire practice. Its misconduct rule includes disciplinary action by a regulatory authority in another domestic or foreign jurisdiction. When another jurisdiction has already decided a disciplinary case, New Hampshire may consider that decision and impose an authorized sanction, but must give the licensee notice and an opportunity to be heard before doing so. The other authority’s decision is not retried through a collateral attack in the New Hampshire sanction proceeding. Ask what the outside action actually was, whether it was disciplinary, and how it affects current fitness or public protection. A complaint alone is different from an established disciplinary action. For a compact privilege, also consider the compact’s separate reporting and eligibility consequences; a privilege is not insulated from action elsewhere.
Worked example: A PT licensed in New Hampshire and another state receives a disciplinary order from the other state. New Hampshire can consider the order when evaluating the PT’s license. It must provide notice and a chance to be heard before imposing a New Hampshire sanction. The PT cannot dismiss the matter merely because the treatment occurred across the border.
Watch the distinction: An out-of-state sanction is not automatically irrelevant to a New Hampshire license. Equally, New Hampshire does not impose its own sanction without the required process.
43. Protected titles and service claims
New Hampshire protects both professional titles and claims that physical therapy services are being supplied. A licensed PT uses “PT” with the name or place of business; a licensed PTA uses “PTA” with the name. An unlicensed person cannot present as a PTA through that title or related initials. The restriction also reaches a person or business using words, abbreviations, advertising, or billing that directly or indirectly imply physical therapy is provided, unless the services are provided by or under the direction of a New Hampshire licensed PT. Evaluate the public impression created by the whole claim, not just a disclaimer in small print. A wellness label cannot cure a conflicting PT title or a bill labeled physical therapy. Conversely, the law does not prohibit every general fitness service; the question is whether the representation or activity crosses the protected boundary.
Worked example: A fitness studio has no New Hampshire licensed PT but advertises staff as “PTAs” and bills visits as physical therapy. The staff title implies a licensed PTA role, while the billing describes a protected service. Calling the visits wellness sessions does not resolve either claim. The studio should stop those representations and arrange services only under proper authority.
Watch the distinction: Changing the business description to “wellness” does not neutralize a protected title or physical therapy billing. Examine what patients and payers are actually told.
44. Practicing without valid authority
Authority to practice depends on the license’s present status, not the clinician’s past qualifications or intention to renew. A timely, complete renewal filing by an eligible licensee keeps the license valid while OPLC acts. Completeness includes the application, fee, and required supporting documents submitted by expiration. If those elements are missing at expiration, the license lapses; the holder cannot practice until reinstatement. The same practical check applies to suspension and restricted authorization: read the effective status and any conditions before scheduling care. A restricted license permits only the work its terms allow, such as a specified scope, place, patient group, or supervision arrangement. Volunteer treatment can still be physical therapy practice. The NPTE-PTA study guide addresses clinical examination preparation, while New Hampshire practice authority turns on the current license or other valid authorization.
Worked example: A PTA’s license expires Friday. The renewal form is drafted, but the fee and supporting records have not been filed. On Monday the PTA is scheduled for patient visits. Because a complete filing was not submitted by expiration, the license has lapsed. The PTA must stop providing PT services and seek reinstatement before returning.
Watch the distinction: Passing an exam or preparing a renewal form does not extend a license. The continuation rule depends on a timely, complete filing by an eligible licensee.
45. Sexual misconduct boundaries
The treatment relationship gives a PT or PTA access to a patient’s body, personal information, and trust. New Hampshire’s misconduct definition therefore covers soliciting or engaging in a sexual relationship with a client while that professional relationship exists, including when the client appears to consent. It also covers sexual advances, requests for sexual favors, and sexual verbal or physical conduct. A separate provision addresses intentionally viewing a partly or fully disrobed client when that viewing is unrelated to diagnosis or treatment. For an examination requiring exposure, explain its clinical purpose, obtain ongoing consent, preserve privacy, and limit viewing to what the task requires. The current APTA Code of Ethics also addresses PT and PTA professional boundaries; the New Hampshire rule supplies the state misconduct test.
Worked example: A treating PT invites a patient on a romantic date, and the patient says the invitation is welcome. The active PT-patient relationship makes the invitation a boundary issue despite that response. The PT should end the advance and keep treatment interactions professional. During care, any necessary exposure must also have a treatment purpose and respect the patient’s consent and modesty.
Watch the distinction: Patient agreement does not remove the prohibition on a sexual relationship during the treatment relationship. Consent to treatment is also not consent to unrelated viewing or advances.
46. Unsafe care without injury
New Hampshire’s misconduct rule measures the quality and safety of care, not only the outcome. Failure to provide care with reasonable skill, safety, and regard for client rights can qualify whether or not injury occurs. Analyze the clinical situation prospectively: what risks were apparent, what precautions were available, and what would a reasonably skilled PT or PTA in that role have done? A near miss may reveal a serious deficiency even if luck prevented harm. Patient rights matter alongside technique, including informed participation, privacy, and a response to refusal. For a PTA, the PT’s established plan and supervision remain part of the decision; for a PT, responsibility includes judging whether an intervention is appropriate and adapting the plan. Documenting an unsafe act accurately is necessary, but documentation alone does not make the care safe.
Worked example: A PT repeatedly transfers a patient without the assistance indicated by the patient’s unstable balance. The patient never falls. The absence of injury does not settle the issue: the foreseeable fall risk, repeated method, and available safer assistance support concern about reasonable safety. The PT should change the transfer approach and address the deficiency before another attempt.
Watch the distinction: No injury does not mean no misconduct. The rule expressly considers unreasonable skill or safety even when the patient escapes harm.
47. Supervision as a misconduct issue
Supervision is a patient safety obligation, not a label on a staffing chart. New Hampshire requires the PT to establish, through written education and training documentation, that assistive personnel can perform their designated tasks. The PT also decides on each service date which interventions need PT expertise and whether using other personnel will be safe and effective for that patient. A licensed PTA may perform selected interventions under the PT’s general supervision. An aide is limited to designated routine tasks and needs direct personal supervision by a PT or PTA: the supervisor is physically present, immediately available, and continuously directing and supervising the task. Those arrangements cannot be swapped merely because the clinic is busy. When assessing possible misconduct, check both the worker’s qualifications and the supervision actually supplied while the task occurred.
Worked example: A PT assigns an aide a routine equipment setup but has no written record of the aide’s training. The supervising PTA then leaves the area during setup. The qualification check is undocumented, and continuous in-person supervision is absent. The PT should verify and record training; the task should resume only when an authorized PT or PTA can provide the required supervision.
Watch the distinction: A task being routine does not make it unsupervised aide work. Training must be established, and direct personal supervision must continue throughout the assigned task.
48. Reporting another practitioner’s conduct
A New Hampshire PT or PTA must report within 30 days an act by someone authorized by the board to practice in the state that appears to constitute misconduct. The wording calls for a judgment about an apparent act, not proof of guilt or a completed disciplinary case. Identify the observed behavior, why it fits a possible misconduct ground, and who holds New Hampshire authority. Preserve factual details rather than adding speculation about motive or diagnosis. If patients face an immediate risk, protect them promptly through appropriate clinical and workplace action; that response does not replace the regulatory report. The reporting clock concerns the apparent act, so waiting for a supervisor’s informal investigation can create a separate lapse. The rule applies to PT and PTA licensees observing another authorized practitioner; it should not be recast as a general duty to report every workplace disagreement.
Worked example: A PTA sees an authorized colleague twice struggle to stay alert while treating patients and observes unsafe handling. The PTA removes patients from immediate risk, records the observed conduct, and reports the apparent misconduct within 30 days. The PTA need not diagnose the colleague’s condition or prove a disciplinary violation before making the report.
Watch the distinction: Reporting is not reserved for proven cases. The rule concerns conduct that appears to be misconduct, while the investigation determines what actually happened.
49. How a complaint begins
Any person may submit a complaint about a licensee or another person who may be violating the New Hampshire PT practice act. The first procedural question is whether the alleged facts, if taken as stated, describe professional misconduct. OPLC makes that initial assessment. If the allegation does not state a claim, OPLC recommends dismissal and the board reviews that recommendation; the board dismisses a complaint that does not state a misconduct claim. If it does state one, the office can investigate under its statutory process. This screen separates a legally relevant allegation from proof: a detailed complaint may justify investigation without establishing that the clinician acted wrongly. A useful complaint identifies the person, conduct, dates, setting, and any supporting records. NH JAM practice questions can help you rehearse that sequence.
Worked example: A patient alleges that a PT repeatedly used an unsafe transfer technique and supplies visit dates and a description of the risk. OPLC assesses whether those allegations state misconduct on their face. Because unreasonable safety is a recognized ground, investigation may follow. The complaint’s filing does not itself prove the transfer was unsafe or determine a sanction.
Watch the distinction: A complaint is neither an automatic disciplinary finding nor something only another clinician can file. Any person may complain, and the allegations are screened.
50. Confidential investigation material
New Hampshire generally keeps complaints, investigation records, and reports confidential while allegations are examined. OPLC’s investigative material is exempt from public disclosure unless it later becomes part of a public disciplinary hearing. The PT practice act separately protects board-held complaints, investigative records, and identifiable patient information unless used in disciplinary proceedings. These protections allow fact gathering without treating an unproven allegation as public guilt and help shield patient details. Confidentiality has defined limits: the office may share acquired information with law enforcement or licensing agencies, and may respond to statutory requirements or court orders. A public hearing can make material used there public, but that does not mean every patient identifier should be casually released. Distinguish the complaint file, the evidence actually introduced, and a final public disciplinary decision.
Worked example: A clinic manager asks OPLC for the entire file on an unresolved complaint against a PT. The investigation records are generally confidential, so the manager has no automatic public access. If evidence from that file is later used in a public disciplinary hearing, that material may become public. Patient information still requires careful handling under the applicable protections.
Watch the distinction: An investigation file does not become public merely because someone filed a complaint. Later use in a public hearing changes the status of relevant material.
51. Notice, evidence and rehearing
Disciplinary process gives the respondent a chance to understand and answer the allegations before an ordinary sanction is imposed. New Hampshire generally requires written hearing notice at least 15 days beforehand, identifying the time, place, and issues, subject to the statute’s stated exceptions. Evidence and testimony are then considered in the proceeding. After a final disciplinary decision, the licensee may petition the board in writing for rehearing within 30 days of receiving it. An appeal follows the decision on rehearing through the prescribed route; filing an appeal does not cause the board to stay a sanction. Keep the procedural steps separate: notice precedes the hearing, a final decision starts the rehearing clock, and a later appeal is not a substitute for timely rehearing. Immediate danger has a special suspension process discussed separately.
Worked example: A PT receives a final disciplinary decision on June 1 and believes material evidence was misunderstood. The PT must submit a written rehearing petition to the board within 30 days of receipt, rather than assuming an oral objection suffices. If a suspension is in effect, pursuing review does not automatically restore practice authority.
Watch the distinction: A request for rehearing is not an automatic stay. Follow the written deadline and obey the decision’s practice restrictions while review proceeds.
52. Discipline and remedial proceedings
New Hampshire separates disciplinary proceedings from non-disciplinary remedial proceedings. Disciplinary proceedings are generally public. Remedial proceedings are generally exempt from public access, but a final remedial action affecting license status, including a non-disciplinary restriction, must be disclosed. This distinction concerns the type and consequence of the proceeding, not whether the original concern seemed serious to a coworker. In both types, the board decides factual questions and determines any sanction; a presiding officer handles hearing procedure and legal rulings and issues final orders based on the board’s factual findings. Settlement or dismissal can resolve a complaint under the governing process. A confidential letter of concern is another non-disciplinary response when evidence is insufficient for discipline, although it may bear on a later pattern. Ask what final action was taken before describing its public status.
Worked example: A clinic employee says every response to a complaint is public discipline. A board may instead use a non-disciplinary remedial proceeding, which is generally nonpublic. If its final action restricts the PT’s license, that status change is disclosed. The board still makes the factual determination; the employee’s label does not decide the proceeding’s legal character.
Watch the distinction: Non-disciplinary does not always mean invisible. A final remedial restriction affecting license status is disclosed even though the proceeding is generally nonpublic.
53. Available sanctions
Sanctions differ in what they permit a PT or PTA to do. A reprimand is formal discipline without itself suspending the license. Probation permits practice only under imposed terms, which may include reporting, education, treatment, or direct supervision. Suspension stops practice for its specified period or until stated conditions are met. Revocation ends the license; returning to practice would require a valid new authorization under applicable law. Authorized administrative fines impose a financial consequence and can accompany another sanction. New Hampshire’s general sanctions statute and PT rules both address available measures, so read the actual order to learn its effective dates and conditions. Financial penalties also require the correct legal authority and findings; a disciplinary fine against a licensee differs from an unlawful-practice penalty against an unlicensed person or entity. Multiple sanctions can be combined when authorized.
Worked example: A PT is placed on probation and ordered to practice under direct supervision. The PT may continue treating only while that supervision and all other order terms are satisfied. The order is more restrictive than a reprimand but does not revoke the license. If the supervisor is unavailable, the PT cannot simply provide the same care independently.
Watch the distinction: Probation is not unrestricted practice. The license remains usable only within the conditions imposed, while suspension and revocation have different effects.
54. How sanctions are selected
Sanction selection starts with identifying the act or omission proved, then examining features that change its seriousness. New Hampshire’s PT rule directs attention to actual or potential physical or mental harm, repetition, prior misconduct, and whether the conduct was intentional rather than negligent or inadvertent. The board then chooses measures that protect the public, prevent recurrence, account for acknowledged fault and cooperation, and correct deficiencies. Potential harm matters even without injury. Repetition must rest on an established prior hearing, relevant settlement, or admission under the rule, rather than rumor. Cooperation can influence the response but does not erase misconduct. Match the remedy to the mechanism of failure: training may address a skill gap, supervision may reduce a continuing safety risk, and intentional deception may require a more restrictive response than an isolated correctable error.
Worked example: Two PTs submit inaccurate treatment notes. One notices an isolated mistake, discloses it, and corrects the record; the other repeatedly invents visits and denies it despite evidence. Both records need correction, but repetition and intent make the second case more serious. The board can weigh harm, cooperation, and future risk when choosing authorized sanctions.
Watch the distinction: The same type of paperwork violation does not require the same sanction every time. Intent, repetition, potential harm, and corrective needs affect the decision.
55. Immediate suspension
Immediate suspension addresses an imminent danger to public health, safety, or welfare. It is an urgent protective order, not a final finding that replaces a hearing. Under New Hampshire’s general sanctions statute, the board may suspend a license pending an adjudicative proceeding to decide whether the suspension should remain while the matter is finally resolved. That proceeding must begin no later than 10 working days after the order unless the licensee agrees in writing to more time. The board must follow the emergency procedure required by law. Separate the trigger from ordinary misconduct: a past error may warrant investigation and eventual discipline, but emergency action requires a current danger that cannot safely await normal timing. Once the order takes effect, the clinician cannot practice merely because the allegations are disputed.
Worked example: A PT’s current conduct presents an imminent risk during patient transfers, and the board orders immediate suspension. The PT stops practicing at once. An adjudicative proceeding must then begin within 10 working days unless the PT agrees in writing to a longer interval. That proceeding tests whether the temporary suspension should continue pending final resolution.
Watch the distinction: Emergency suspension is not the final disciplinary hearing. It temporarily protects patients and must be followed by the prompt process specified in law.
56. Recovery instead of discipline
New Hampshire permits a non-disciplinary substance abuse recovery route for an eligible licensee when the board has evidence of impairment. Eligibility also excludes a person convicted of a felony relating to a controlled substance under the provision. The licensee must enter a written agreement for a restricted license, comply with its practice limits, and make satisfactory progress in a board-approved recovery program. The agreement includes a waiver allowing the program to inform the board if the licensee fails to comply or cannot practice with reasonable skill or safety. Successful compliance and completion are treated as non-disciplinary under the PT rule. The restricted license remains a real limitation on patient care; it is not permission to work while impaired. Failure to enter the required agreement activates investigation and disciplinary proceedings, while noncompliance can also expose a safety problem.
Worked example: A PTA has documented impairment, meets the program’s eligibility conditions, and signs a restricted-license agreement requiring monitoring and specified work limits. The PTA may work only within those limits while progressing in the approved program. Completion through compliance follows the non-disciplinary route. Refusing the agreement instead triggers investigation and disciplinary proceedings.
Watch the distinction: The recovery option is neither automatic immunity nor unrestricted practice. Its non-disciplinary treatment depends on eligibility, a written restricted-license agreement, and compliance.
57. Stopping unlawful practice
Unlawful practice can involve treating without required authority, advertising oneself as qualified, or continuing after notice of suspension or revocation. New Hampshire allows action against a person or entity, so a clinic’s marketing can matter even if no individual licensee is named. An injunction is a court order aimed at stopping the conduct; it serves a different purpose from discipline imposed on someone who holds a license. After notice and an opportunity to be heard, an affirmative finding of unlawful practice can support an authorized financial penalty. Each violation may be treated separately. The board, attorney general, or an authorized local prosecutor may seek an injunction, and that remedy does not displace other available remedies. Start by identifying the unauthorized act, then ask whether immediate cessation, a formal penalty, or both is needed.
Worked example: An unlicensed clinic keeps advertising physical therapy after being told its claims lack proper authority. The state may seek an injunction to stop the advertising and related practice. Following notice and a chance to be heard, an unlawful-practice finding may also support a financial penalty. Stopping the advertisement and penalizing the violation serve different functions.
Watch the distinction: A state response is not limited to disciplining licensees. An unlicensed business can face an injunction and a separate unlawful-practice penalty.
Consumer Advocacy
58. Paid referral disclosure
A patient should know when the practitioner sending them to physical therapy benefits financially from that referral. New Hampshire requires the PT to disclose in writing, before the initial evaluation, direct or indirect compensation that the referring practitioner derives from the PT referral. The timing matters: disclosure after treatment has begun deprives the patient of information when choosing where to be evaluated. Direct compensation might be an explicit payment tied to referrals; indirect compensation can involve another financial arrangement that rewards the referral. The PT’s duty is triggered by the compensation relationship, even if the PT did not create it. Identify who receives the benefit, how it relates to the referral, and whether the patient received a written disclosure before the first evaluation. Disclosure supports an informed choice; it does not replace honest clinical judgment.
Worked example: Before a new patient’s evaluation, a PT learns the referring practitioner receives compensation tied to referrals to the clinic. The PT gives the patient written disclosure before beginning the evaluation. The patient can then decide whether to use that clinic. A verbal explanation alone would not satisfy the rule’s written-disclosure requirement.
Watch the distinction: Disclosing a paid referral after the initial evaluation is too late under this rule. The patient needs written information before that evaluation begins.
59. Product interests and free choice
A product recommendation can serve a patient’s treatment goals while also benefiting the PT financially. New Hampshire requires the PT to disclose in writing any financial interest in a product the PT endorses and recommends, at the time of that endorsement or recommendation. The PT must also tell each patient that they are free to choose services and products. Apply the rules together: first decide whether the product is clinically appropriate; then identify the financial interest, disclose it in writing when recommending the item, and make the patient’s options clear. A financial interest need not make the product ineffective, but hiding it can distort the patient’s decision. The patient may choose another supplier or suitable product. The PT should avoid treating a clinic’s sales arrangement as a reason to pressure the patient or narrow their choices.
Worked example: A PT recommends a brace sold by a company in which the PT owns a share. At the recommendation, the PT gives written disclosure of that interest and tells the patient they may choose another suitable brace or supplier. The clinical recommendation can still be discussed, but the patient’s purchase choice remains their own.
Watch the distinction: A useful product is not exempt from financial-interest disclosure. Clinical value and the PT’s ownership interest are separate facts the patient should understand.
60. Verifying a provider and raising concerns
Patients need a practical way to identify who is authorized to provide their PT care and to raise concerns when something appears wrong. At the place of practice, each New Hampshire licensee must display a copy of the license, current renewal verification, or a notice explaining that the information is available, where the public can see it. This makes credential checking possible without assuming that a name badge proves current authority. Any person may submit a complaint about a licensee or another person potentially violating the PT practice act. A useful concern describes specific conduct, dates, people involved, and any records or witnesses; OPLC and the board then apply the complaint process. The right to complain does not guarantee a misconduct finding. License display and complaints work together: one helps patients verify authorization, and the other provides a route to examine possible violations.
Worked example: A patient cannot find a clinician’s license information at a clinic and believes an aide performed unsupervised treatment. The clinic must make the license, current renewal verification, or availability notice publicly accessible. The patient may submit a complaint describing the visit and supervision concern. OPLC screens the allegation; the patient’s concern does not itself establish a violation.
Watch the distinction: A patient need not prove misconduct before complaining. Likewise, a missing wall certificate alone does not settle compliance if an accessible renewal verification or availability notice is displayed.
Official references and further reading
- FSBPT current New Hampshire JAM format and scope
- FSBPT currently linked New Hampshire JAM complete content outline
- FSBPT current New Hampshire JAM legal reference: complete laws, rules and selected policy text
- APTA current Code of Ethics for the Physical Therapy Profession