You Must Create a Password

You must create a password by clicking on "Forgot your password?" on the Jurisprudence Module log in page before you can begin the Module for the first time.  

Your username is your email address on file with the College. 

Create a New Password: Jurisprudence Module

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• reset
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If you can't log in to your account, please visit the “Forgot Password” page and enter your email address all in lower case.

If your email address is valid, you will be emailed a link to reset your password.

If you need assistance, please contact the College at 416-591-3828 ext. 222 or 1-800-583-5885 ext. 222 or email jurisprudence@collegept.org. 

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Be sure that you are entering your email address all in lower case.

As a reminder, the College sends emails to the email address that it currently has on file. If you have changed your email address, please update it with the College and email us at jurisprudence@collegept.org so that you can access the Module. You can update your information by going to the Update Your Information in the PT Portal on the website. Click the SIGN IN button.

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We recommend that you use Google Chrome to complete the Module. Download Google Chrome if you do not already have it installed on your computer. 

Download Google Chrome

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The College uses a third-party vendor to administer the Jurisprudence Module.

Please complete the module here.

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• jurisprudence

We recommend a speed of at least 10 Mbps. You may want to test your internet speed before starting the Module. You can do this by using one of these tests:

http://speedtest.googlefiber.net/
http://beta.speedtest.net/
https://fast.com/

A speed less than 10 Mbps may lead you having difficulty completing the Module. Please consider finding a better internet connection before beginning your Module.

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Yes. You are free to enter and exit the Module as many times as you like. It will only count as an attempt when you click “Submit Module”.

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Yes. You have access to a tutorial. We recommend that you take the tutorial before attempting the Module, so you can become familiar with how it works. Go to https://cpo.ysasecure.com/login and enter the same access credentials that were provided to you to be able to access the Module.

Please note, the questions in this tutorial have nothing to do with the questions you will be asked to answer when completing the Jurisprudence Module. The tutorial’s goal is to familiarize you with the software you will be using to complete the Module and test whether your computer set up is compatible.

Access Tutorial

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If you have any questions about the Jurisprudence Module, please contact the College at jurisprudence@collegept.org or by phone at 1-800-583-5885 ext. 222 or 416-591-3828 ext. 222.

If you require an alternate format or have an accessibility question, please contact communications@collegept.org.

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We recommend that you take the tutorial before the Module (refer to tutorial questions above). 

Below is a summary of the navigation features:

• Skip questions by clicking on “Go to Next Question” button:
  
  
  
  
• Bookmark questions by clicking the “Bookmark / Ribbon” icon in the top toolbar on the computer screen:

• Get unanswered or bookmarked questions by selecting one of the following buttons in the top toolbar on the computer screen:

• Provide any comments or feedback using the “Online Notes” field. Click the “Clipboard” icon in the top toolbar:

• Review and change your answers until you have clicked the “Submit Module” button at the end:

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After clicking “Submit Module” you will see a message that confirms that you have submitted the Module correctly. It will show the date and time, the score you received, whether you passed or failed and will then provide a list, question by question, noting whether you answered that question correctly or incorrectly. All of this information will be stored electronically, and the College will have access to it.

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No, it is not possible to print the Jurisprudence Module or to download it.

This is done as a security measure to prevent the widespread sharing of the questions and answers. You are encouraged to work with colleagues and other physiotherapists to discuss and learn, but the inability to print is meant to stop people from sharing the correct answers. You can enter the Module as many times as you like, and your answers will be automatically saved.

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You can log back into the Module and click on “Profile” at the top right side of the menu bar, then “History” and a summary of your activity to date will appear. The summary does not include which questions you’ve answered correctly or incorrectly. 

The summary shows:

• when you started and/or completed the Module

• what your mark was out of 60

• whether you passed or failed

Please note it is NOT necessary to document your score or have a copy of Jurisprudence Module for any reason. The College will never request this. The only records we refer to are the ones provided by the third-party vendor that hosts the Jurisprudence Module for the College. Once you successfully complete the Module, your work is done!

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You are not able to download the questions or answers to the Jurisprudence Module. When you hit “Submit Module” you will see a summary of the questions you got right and the questions that were wrong.

Once the Module has closed, the College will receive a report of the results of all physiotherapists who attempted the Module. This information is used to prepare educational tools and resources for registrants in the future.

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The Jurisprudence Module will be available from October 3 to December 2, 2024.

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The Module is made up of approximately 60 multiple choice questions. These questions cover: confidentiality, privacy, conflict of interest, consent, continuing competency, practice management, professional boundaries, record keeping, a physiotherapist’s obligations, scope of practice, use of title and working with physiotherapist assistants.

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You will have two months. This year the Jurisprudence Module will be available from October 3 to December 2, 2024.

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If you do not pass the Module, you will not be eligible to apply for an Independent Practice certificate under the exemption policy. You will be able to continue practicing as a Physiotherapy Resident with your Provisional Practice certificate. If you are having difficulty with a particular question, you should re-read the relevant College Standards. The Jurisprudence Module is an open book format, so make use of all of the resources available to you. Visit the College website for assistance and discuss with your peers.

If you do not successfully complete the Jurisprudence Module after two attempts, you will be invited to participate in a Jurisprudence workshop at no charge and will have an opportunity to re-attempt the Module. The College will contact you in early January 2025 to set a date and time for this workshop.

Please feel free to contact us at jurisprudence@collegept.org or by phone at 1-800-583-5885 or 416-591-3828 ext. 222 and we are happy to answer your questions about next steps.

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The Jurisprudence Module is a mandatory activity for all physiotherapists who registered in Independent Practice in the last year. You must successfully complete the module in order to maintain your registration. If you do not attempt the Jurisprudence Module, you will be referred to the Inquiries, Complaints and Reports Committee.

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• acupuncture-programs
• acupuncture-training
• controlled-acts
• restricted-activities

• roster
• acupuncture
• dry-needling

• rostering
• acupuncture

We know it’s a confusing exception. There is some history and reasoning behind it, though. It’s based on how the authority to perform controlled acts is granted by law. 

Under the Physiotherapy Act, PTs have the ability to 1) communicate diagnosis, 2) perform tracheal suctioning, 3) administer a substance by inhalation, 4) do wound care, 5) perform spinal manipulation, and 6) insert a hand, finger or instrument beyond the labia majora or anal verge to assess or rehabilitate pelvic musculature.

Physiotherapists are able to delegate their authority to another person (an assistant or an occupational therapist, for example) for three activities only: tracheal suctioning, administering a substance by inhalation, and wound care. College Council decided that communicating a diagnosis, spinal manipulation and internal pelvic treatment were too risky to delegate.

Health care professionals are able to teach patients and families a controlled act (such as tracheal suctioning) if a patient requires it for the activities of daily living. 

There is a provision in the Regulated Health Professional Act to address this. There is also a provision allowing students to perform controlled acts under supervision, if said acts are necessary to fulfill their professional qualifications and begin practice.

Physiotherapists have NOT been given direct and specific authority to perform acupuncture. 

Under the Physiotherapy Act, PTs have the ability to:

1. communicate a diagnosis,

2. perform tracheal suctioning,

3. administer a substance by inhalation,

4. perform wound care,

5. perform spinal manipulation, and

6. insert a hand, finger or instrument beyond the labia majora or anal verge to assess or rehabilitate pelvic musculature.

Physiotherapists are able to delegate their authority to another person (an assistant or an occupational therapist, for example) for three activities only: tracheal suctioning, administering a substance by inhalation, and wound care. College Council decided that communicating a diagnosis, spinal manipulation and internal pelvic treatment were too risky to delegate.

Health care professionals are able to teach patients and families a controlled act (such as tracheal suctioning) if a patient requires it for the activities of daily living. 

There is a provision in the Regulated Health Professional Act to address this. There is also a provision allowing students to perform controlled acts under supervision, if said acts are necessary to fulfill their professional qualifications and begin practice.

Physiotherapists have NOT been given direct and specific authority to perform acupuncture. 

It was not always regulated, and while it wasn’t, anyone could do it. 

When the government started regulating acupuncture, they allowed physiotherapists to continue doing it, but only as a special exemption. That means no component of acupuncture (even removing needles) can be delegated. 

This requirement is not part of our College rules, but it falls to us (the College) to ensure the Standard is enforced.

So please remember that you cannot delegate any part of acupuncture to anyone—it’s all you! 

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• acupuncture

Under the law (RHPA, Sched. 2, s.1 (3,4)) it is considered to be sexual abuse when a health care provider touches, behaves or makes remarks of a sexual nature towards a patient—as well as having physical sexual relations.

If a physiotherapist is dating a patient and doing any of these things it constitutes sexual abuse, and there is a zero tolerance policy. It does not matter if the patient starts the relationship or consents to the relationship.

Being found guilty of sexual abuse can result in the loss of your ability to practice as a physiotherapist. Colleges are required to revoke (take away) the registration of members found guilty of sexual abuse. It really is a big deal. The Regulated Health Professions Act states:

(5) If a panel finds a member has committed an act of professional misconduct by sexually abusing a patient, the panel shall do the following in addition to anything else the panel may do under subsection (2):

1. Reprimand the member.

2. Revoke the member’s certificate of registration if the sexual abuse consisted of, or included, any of the following,

i. sexual intercourse,

ii. genital to genital, genital to anal, oral to genital, or oral to anal contact,

iii. masturbation of the member by, or in the presence of, the patient,

iv. masturbation of the patient by the member,

v. encouragement of the patient by the member to masturbate in the presence of the member. 1993, c. 37, s. 14 (3).

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• reporting
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• relationship

You are correct, it is against the law to date a current patient. You must wait at least one year and there are other things you must think about in this situation. Dating a past patient is often not a good idea. Given the role a physiotherapist plays in a person's recovery and the therapeutic relationship shared, a power imbalance exists between the patient and the PT. There is a risk that a patient may become dependent on their physiotherapist. However, it is possible to date a former patient if all the following apply:

- at least one year has passed since the patient was discharged from your physiotherapy care

- there is no power imbalance between the physiotherapist and the patient, and 

- the patient is no longer dependent on the physiotherapist.

Still not sure? Why not contact the Practice Advisor and talk it through. advice@collegept.org or 647-484-8800 or 1-800-583-5885 ext. 241.

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Video Resources: Redirecting Inappropriate Patient Behaviour: Verbal Techniques

I Think, I Feel, I Want

Active Listening and Broken Record

The Positive/Negative Warning

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• reporting
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• relationship

• Abuse
• mandatory-reporting

The Registrar (CEO) will forward the report to the Inquiries, Complaints and Reports Committee. The Committee will review the report and any supporting documentation (the member's response for example) and decide if there are grounds to request a formal investigation. 
 
The Committee can make the following decisions:

- Refer allegations of professional misconduct or incompetence to the Discipline Committee 

- Refer allegations of incapacity to the Fitness to Practise Committee 

- Issue a Caution to the member 

- Provide advice to the member 

- Negotiate an Undertaking agreement with the member 

- Take no action

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1. Privacy: you cannot discuss any health information outside of the clinical setting

2. Communication: a physiotherapist needs to ensure discussions with patients about their care remains within a “clinic setting”.

3. Maintaining professional objectivity: moving from a professional to a personal relationship may impact your ability to remain objective during delivery of care.

There are no simple yes or no answers to these questions but a PT should carefully consider the impact that attending such a function might have on their professional relationship with a patient.

Boundaries and Sexual Abuse Standard

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The answer to this depends on the circumstance. Sometimes it will be OK and other times not.

Some of it depends on the gift itself and some of it depends on the patient and whether there is an expectation that you do something in return. Always consider it from the patient’s point of view. Occasionally it might do more harm than good to refuse the gift.

Some examples:

On their last visit, a patient gives you a card with a $50 gift card. This is probably OK. The patient has completed their treatment and expects nothing in return.

A patient’s mom is grateful for the care you are providing her son and wants to make sure you don’t discharge him. She wants to give you $50. You should decline this offer.

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Sometimes a physiotherapist will find themselves in a social situation that involves their patients. As a PT, your children may attend the same school as your patient, your patient might live in your neighbourhood, or attend the same gym that you do. In these circumstances socializing may be unavoidable. What is important is how you manage the situation and the potential for a boundary crossing. Physiotherapists must set limits (boundaries) when they see a person both inside and outside of the clinical environment. This creates a safe place for the patient and prioritizes their care.

Boundaries are limits that establish identity, maintain privacy, avoid entanglement and allow for safe and professional interactions. Boundaries are the invisible lines that are drawn to help define roles and interactions in relationships. When these lines are crossed, negative consequences may result. According to the College’s Boundaries and Sexual Abuse Standard, the physiotherapist’s responsibility is to always act in the patient’s best interest and manage the boundaries within the therapeutic relationship.

One of the important risks to note when providing services to a person you interact with both professionally and in-person is that your clinical objectivity may be affected when you assess or treat that person. In this case, knowing this person’s family for example may make the patient feel less comfortable sharing sensitive information with you. Or because of your familiarity with them, you could be tempted to take shortcuts with record keeping or discussing consent for example.  Patient confidentiality must be carefully protected as there is risk of accidently breaking confidentiality is higher when you interact with someone both personally and professionally.  

Tips:

- Do not discuss patient care topics in non-clinical settings

- Develop strategies to redirect treatment-related questions to the clinic setting and social questions to a personal setting.

For example:

If the patient's injury or condition comes up at the park or a party, be prepared to say something like "I am happy to look at the injury in the clinic at our next treatment session." And if a patient starts to discuss something personal when you are treating them, be prepared to say something like “Let’s chat more about that when I see you at the hockey game on the weekend.”  

"I know exactly where my professional boundaries are; they are the four walls of my clinic, and outside of them, I don’t discuss client care, and inside of them, I don’t have personal conversations."
    
-Reference "Where's the Line" Professional Boundaries in a Therapeutic Relationship.

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It may be difficult to identify that a business or a patient is billing inappropriately for extended health benefits care unless a problem has been identified during an audit conducted by an extended health insurer. But for auto insurance claims, PTs do have the ability to ask the College to check the Professional Credential Tracker (PCT) provided by Health Claims for Auto Insurance (HCAI). The PCT uses HCAI data to identify who has a health professional’s credentials. To access the PCT you would need to contact the Practice Advisor to provide your name, registration number and an email address where your report can be sent. Contact the Practice Advisor at advice@collegept.org to request a PCT report. You can also get information about reporting errors.

Some of the possible problems noted in the PCT Reports are:

- Listings that include variations on the spelling of your name

- Profession is incorrectly identified

- Previous employers have not submitted an ‘end date’ when you left the practice 

- PTs find clinics listed on the report that are unknown to them

- A different provider name is on your report

- A facility where you deliver care to MVA patients is missing from your report

- The report does not include a list of specific patient names or treatment dates. 

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Receipts should only be provided when money is actually received and should reflect exactly the service that was provided and the exact amount collected. Anything else is fraudulent.

Care should only be provided based on a patient’s need, not in anticipation of what the insurance company will pay for, and under no circumstance should PTs be helping patients defraud their insurance company!

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Many times physiotherapy treatment involves exercise prescription. A PT uses judgement and collaborates with a patient to determine if they will be able to participate in the exercise plan with a personal trainer independent of a PT or will need the guidance and close monitoring by a PT. The latter scenario is physiotherapy. It should include all the required elements of assessment, treatment planning, outcome measures, documentation etc. Your services should align with what the patient needs and not what you are able to bill insurance for.

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• billing

• billing
• registration-number

Charging a set fee for a block of services may be permissible provided certain conditions are met. These conditions are described in the Professional Misconduct Regulation which states that the services included in the block should be specific to the patient and the patient should be given the choice whether or not to participate.

Should the patient require fewer sessions than what they have purchased, the difference should be refunded. Otherwise, the invoice would not accurately reflect the service that was provided and the fee could be considered excessive for the service that was received.

Refer to the Fees, Billing and Accounts Standard

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Yes, physiotherapists can provide care in a variety of settings, including in their home. Physiotherapists must ensure that care can be provided safely, effectively, and professionally, and that they are able to meet all College standards in their practice environment.

The College has a checklist Opening a Practice Checklist to support PTs in meeting the required standards in any setting. This includes information around physical work environment, fees, billings and accounts, infection control, record keeping and other considerations. Be sure to check out the FAQs for information around required written policies. When starting a new practice, physiotherapists must update their information in the College portal within 30 days.

Consider the set up in your home to ensure patient privacy. Consider also how you will manage both the environment and professional boundaries so that the home practice setting feels professional and safe for both you and your patients.

There may be city zoning by-laws or other municipal regulations that impact your ability to operate a business from your home.

Finally, a special consideration during the pandemic is to ensure that physiotherapists are familiar with and following all COVID-19 infection control guidelines set out by the Ministry of Health.

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If you see patients privately, no matter the location, you are operating a private practice, and you’ll need to update your information on the PT Portal.

You will also require a business address for the purposes of providing contact information to patients and third-party payers. If you don’t have a physical clinic, you can use your home address as the business address. If you prefer not to have your home address listed on the Public Register, you can use a P.O. box, which you can rent from a post office or other facility.  

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You will need written policies and procedures for the following:

- How you will ensure privacy/keep patient information safe

- Managing adverse events (if you do any controlled acts)

- Written protocols for infection prevention and control 

- Written process for routinely reviewing the maintenance and safety of equipment 

- Communicating with the PTA (if the PTA ever treats patients when you are not present)

- Informing patients of your fees for your physiotherapy services

- Reviewing fees and billings

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• consent

They could tell you to:

- not collect, use or disclose a particular item of personal health information, such as a specific diagnosis, for health care purposes, 

- not to collect, use or disclose the contents of their entire record of personal health information, or

- not to use or disclose their personal health information to a particular individual or group.

A patient cannot stop you from recording personal health information that is required by law or by College Standards. But once a patient locks personal health information, you cannot use or disclose the information, unless the individual provides express consent, or unless the law allows you to disclose the locked personal health information (for example, in an emergency).

If you later need to share information about the patient with another health care provider, and you don't have the patient's consent to disclose all the personal health information you feel is necessary, you must notify the receiving health care provider of that fact (i.e., that there is information being withheld at the patient's request - but not the information itself). The receiving provider would then be able to explore the matter of the locked personal health information with the patient and seek their express consent to access the locked information. 

Here is a link to a Fact Sheet put out by the Office of the Information and Privacy Commissioner of Ontario

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• record-keeping
• lock-box

• consent
• age-of-consent

You should give the patient all the information they need to be fully informed about the proposed assessment or treatment.

You will want to discuss the following and personalize to the patient's condition, needs and values:

- What you propose to do 

- How they will benefit

- Any potential and material risks or side effects

- Any other viable options

- The consequences of not receiving treatment 

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

- The costs involved

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• informed-consent

Patients can give their consent expressly (either verbally or in writing) or it can be implied (by words, behaviour or circumstances).

Having a patient sign a form does not ensure they understand. You need to take time to provide all the information they need to make a decision and answer any questions they may have.

Check in with them often. Even if a patient initially consents, they can refuse treatment or change their mind and withdraw their consent at any time. 

Document in the patient's chart that consent was obtained. Include information such as: the information discussed, who was involved in the discussion, and the questions asked and answered. If you do have the patient sign a written consent form, be sure to include it in the patient's chart.

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• proof-of-consent

Yes! The supervising physiotherapist needs to get consent to involve others in the patient’s care. This includes students, physiotherapist assistants and volunteers. You should discuss your role and responsibilities with the patient as well as those of the student, PTA or volunteer. 

You can have the student introduce themselves to the patient and explain their role as long as the patient understands who the supervising PT is, and that they are available to answer questions the patient might have.

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• student
• physiotherapist-assistant
• volunteer

• consent
• substitute-decision-maker

• paternity-leave
• registration
• maternity-leave

Please contact the College at least two weeks before returning to work. You must re-apply for registration by completing an Independent Practice form. If you have applied for a fee credit within the last 12 months, you can use it towards the fee when you return. Contact the Registration department to learn more.

• paternity-leave
• maternity-leave
• return-to-practice

Yes, you need insurance coverage. Your plan must include tail coverage. The standard coverage is for 12 months of leave but first check directly with your insurance provider.

The policy should also provide coverage for claims made up to 10 years after you stop practicing; that is, patients may claim against your practice period after it ends.

Your insurance policy should have:

• a minimum coverage of $5 million dollars for the annual policy period
• a liability limit of at least $5 million dollars per incident
• no additional terms, conditions or exclusions, other than standard
• no deductible
• coverage for claims made up to 10 years after you stop practicing; that is, patients may claim against your practice period after it ends.

Two commonly used insurance providers for professional physiotherapists are the Canadian Physiotherapy Association and Physiosure. There are, of course, many other independent choices.

• paternity-leave
• insurance
• maternity-leave

• collaborative-care

• referral
• collaborative-care

Yes. The Advertising Standard was revised by Council effective February 1, 2019. Testimonials can now be used in advertisements for physiotherapy care. All testimonials must be true, verifiable and accurate. This means that  testimonials need to be genuine, not paid for or written by the PT or clinic staff, but written by patients who received care.

• advertisements
• testimonials

Yes you can. Likes, stars and ratings are also acceptable.  

• advertisements
• social-media
• reviews

Whenever you (as the PT) use your professional title in support of something, you will want to be sure it is done appropriately, professionally, and within the scope of practice. Your opinion must be free of bias or conflict of interest and there must be science and evidence to support the use of the product.

• endorsement

No. A physiotherapy clinic or service provider cannot claim superiority over another one. Using words like “best” or “better than” to describe the physiotherapy delivered and comparing it to another provider is not permitted under the Advertising Standard.

You can describe the quality of care by using words such as “the best care possible” or “the highest quality of care” without comparing yourself to another provider. This is acceptable.

• advertisement
• superiority

Physiotherapists may give deals or discounts (for example, a Groupon) to offer financial help to patients who need care. The PT must perform a comprehensive assessment (and reassessment), and any treatments provided must be therapeutically necessary.

The physiotherapy services should meet all relevant standards, such as you cannot provide care that is of a lesser quality because there is a promotion attached. If the Groupon or deal is for a package of services and the patient requires fewer sessions than what was purchased, the difference should be refunded.

• physiotherapy
• advertising
• advertising-standard
• physiotherapist
• advertisement
• advertise
• packages
• promotions
• discounts
• deals

Charging a set fee for a block of services is permitted provided certain conditions are met. These conditions are described in the Professional Misconduct Regulation which states that the services included in the block should be specific to the patient and the patient should be given the choice whether or not to participate.

Should the patient require fewer sessions than what was purchased, the difference should be refunded. Otherwise, the invoice would not accurately reflect the service that was provided and the fee could be considered excessive for the service that was received.

Have a look at the Fees, Billing and Accounts Standard to learn more.

• package-deal
• billing
• advertisement

• controlled-acts

There are seven controlled acts (sometimes referred to as authorized activities) that Ontario PTs can perform. A physiotherapist must roster (complete an online declaration) with the College if they perform any of the following controlled acts. 

- Spinal manipulation

- Tracheal suctioning

- Acupuncture (this includes dry needling)

- Treating wounds below the dermis by cleansing, soaking, irrigating, soaking, probing, debriding, packing or dressing

- Inserting a hand, finger, or instrument beyond the labia majora or anal verge for the purposes of assessing or rehabilitating pelvic musculature relating to incontinence or pain

- Administering a substance by inhalation (when the substance has been ordered by an authorized person)

Physiotherapists do not have to roster for communicating a diagnosis identifying a disease, physical disorder, or dysfunction as the cause of a person's symptoms because this is a fundamental part of PT practice. Learn more about rostering. 

• rostering
• authorized-activities

Rostering is the process where physiotherapists add their names to a public list indicating they have the required training, education and experience to safely perform the higher risk activity. Physiotherapists who perform authorized activities must roster for each individual authorized activity they perform. 

The only exception is communicating a diagnosis. This is an authorized activity that does not require rostering as it is considered an essential competency.

PTs must roster for the following activities:

- tracheal suctioning

- spinal manipulation

- acupuncture (including dry needling)

- treating a wound below the dermis

- pelvic internal exams (this includes putting an instrument, hand or finger, beyond the labia majora, or beyond the anal verge)

- administering a substance by inhalation

Read the Controlled Acts and Other Restricted Activities Standard to learn more. 

• rostering
• controlled-acts

Physiotherapists may delegate 3 of the controlled acts they are authorized to perform: tracheal suctioning, wound care and administering a substance by inhalation.

Physiotherapist may NOT delegate: acupuncture, communicating a diagnosis, spinal manipulation, or internal assessment treatment of pelvic musculature

Before delegating to another person, physiotherapists must document that they have:

- Ensured the person they are delegating to has the knowledge, skills, and judgment to carry out the activity safely, competently, and ethically.

- Explained when the person can and cannot perform the controlled act. If the patient’s condition changes or they are high risk for example, it may not be appropriate to delegate a controlled act in this case. 

- Ensured that the person who is carrying out the activity knows how to manage any adverse outcome that can reasonably be foreseen. They must be familiar with the written plan that has been created by the person delegating the activity.  

- Confirmed that the person knows they must not delegate the act to anyone else.

• controlled-acts
• delegation

• delegation

Yes, you can delegate 02 titration to a PTA. Physiotherapists can delegate to anyone who has the knowledge, skills and judgement to safely and competently perform the activity – this includes assistants and anyone other health care professional the PT believes is competent. 

The acts that can be delegated are:

- administering O2

- suctioning

- wound care

The acts that cannot be delegated are:

- acupuncture (dry needling) and this includes all parts, even removing needles

- spinal manipulation

- communicating a diagnosis

- internal assessment and treatment of pelvic musculature

Remember, when delegating a controlled act to another person, the physiotherapist must document that they have:

- Made sure the person performing the act has the knowledge, skills, and judgement to do so safely, competently and ethically.

- Explained the circumstances in which the person can perform the controlled act, as well as the types of patient with the certain conditions and any other limitations.

- Ensured the assistant knows how to deal with possible adverse outcomes and has a written plan.

- Confirmed that the person they are delegating understands that they cannot delegate this act to anyone else.

Please consider using the Physiotherapist Assistant Competency Checklist when assessing competency and considering delegating any activity.

• physiotherapist-assistant
• rostering
• authorized-activities

• physiotherapist-assistant
• rostering
• authorized-activities

If the PTA is changing the delivery of oxygen from the wall to a portable tank, they will need to set up the portable O2 system which is administering O2 and delegation is required. 

This activity involves risk. The PTA needs special knowledge to do the activity. 

For example, the PTA will need to make sure the tank is turned on and has enough oxygen in it. They will need to be certain that they reconnect the hose to the oxygen and not to the air valve. The PTA should know whether to monitor SpO2  during the activity, meaning they may need to increase the flow rate if the patient desaturates. This activity could be a risk to patients and therefore requires delegation. If the patient requires a face mask for their O2 needs, the PTA will need for example to understand the impact on FiO2 and any humidification requirements.

• physiotherapist-assistant
• rostering
• authorized-activities

• physiotherapist-assistant
• rostering
• authorized-activities

• controlled-acts
• collaborative-care

Physiotherapists must be able to prove that they have successfully completed training for the controlled acts they perform. This can be formal education or training delivered on the job. During the training, the physiotherapist must: 

• Learn the indications, contraindications, adverse outcomes, and risks associated with performing the controlled act. 
• Practice the controlled act under the supervision of a person who is authorized to perform it. 
• Be evaluated on the knowledge, judgement, and practical skills needed to perform the controlled act.
• Show that they are able to safely and competently perform the controlled act. 

You can find the full list of requirements that need to be in place before performing a controlled act in the Controlled Acts and Restricted Activities Standard. 

• rostering
• controlled-acts
• training

In Ontario, physiotherapists are legally authorized to perform a number of activities referred to in the Regulated Health Professions Act, 1991 (“RHPA”) as controlled acts (or authorized activities). These are activities that are seen to involve a higher level of risk than other activities, so only certain regulated healthcare professionals can perform them. 

Physiotherapists are entitled to perform the controlled act / authorized activity of tracheal suctioning if they are on the College’s roster allowing them to perform this activity (which means they have received specific training with respect to this procedure), or they can perform tracheal suctioning if it has been delegated to them by another regulated professional (such as a physician) who has the legal authority to perform tracheal suctioning. Physiotherapists should not accept delegation of any controlled act that they do not believe they are competent to perform. Physiotherapists are encouraged to review the Controlled Acts and Other Restricted Activities Standard before undertaking this work.  

The actual controlled act involved in performing tracheal suctioning involves putting an instrument, hand or finger 

• beyond the point in the nasal passages where they normally narrow,
• beyond the larynx, or
• into an artificial opening into the body 

With the current health human resource shortages, physiotherapists may be asked to assist with patient care in ways they have not experienced before. 

Physiotherapists may require additional training to enhance their skills so that they can provide safe, competent care.  

Practice Supervisors must hold an Independent Practice Certificate of Registration in Ontario and must have held it for the last three years.

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

Physiotherapy Residents are allowed to have more than one Practice Supervisor.

Supervisors may not supervise more than three Physiotherapy Residents at one time.

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

- is the subject of an investigation

- is involved in remedial activities directed by the College

- has a history of practice concerns

• practice-supervisor

The responsibilities of the Practice Supervisor include:

- Agreeing to the terms of the supervision by completing the Practice Supervision Agreement (in Online Member Portal) and submitting it to the College.

- Supervising the Physiotherapy Resident’s practice.

- Communicating with the College as needed. Practice Supervisors no longer have to submit regular reports to the College.

All registrants must comply with the legislation, regulation, By-laws and Standards.

Practice Supervisors may only supervise care that they themselves have the knowledge, skills, and judgement to give. This applies to all areas of practice including rostered activities.

Review the Supervision Requirements Summary Table for more information. 

• practice-supervisor

The level of appropriate supervision will depend on the practice circumstances. The Practice Supervisor has a duty to ensure that the Physiotherapy Resident has the knowledge, skills, and judgement to deliver care with the same quality as the Practice Supervisor would.

The Practice Supervisor and Physiotherapy Resident do not have to work at the same employment site as long as they can show there is adequate supervision.

Review the Supervision Requirements Summary Table for more information. 

• practice-supervisor

Although the College no longer requires routine reports (the Provisional Practice Monitoring Tool or the Clinical Performance Instrument) from Practice Supervisors, they may still need to give evidence if there are questions or concerns about the supervision.

It is important to keep records. For example, if you have check-in meetings, keep a record of the dates and what you discussed. If you have set learning goals, keep track of how things are progressing. If you conduct chart reviews, record the results.

• practice-supervisor

Practice Supervisors must report to the College if any of these situations occur:

- They learn that a patient has been sexually abused by the Physiotherapy Resident.

- They believe that the Physiotherapy Resident is incompetent, incapacitated, or unable to deliver safe patient care.

- The Physiotherapy Resident is terminated for reasons of professional misconduct, incompetence (lack of knowledge, skills, or judgement) or incapacity (health challenges that pose a risk to patient care).

- The Physiotherapy Resident is facing termination of employment but resigns before being terminated.

- The Physiotherapy Resident is involved in a workplace progressive discipline or remediation process.

• practice-supervisor

A Provisional Practice Certificate is valid for 6 months and can be extended. 

You can work as long as your Certificate of Registration is valid. If you forget the date that your Certificate will expire, log in to the College PT Portal or check the Public Register. 

• provisional-practice

No, you can apply for a Provisional Practice Certificate even if you do not have a job set up.

• provisional-practice
• employment

Yes. You can apply for a Provisional Practice Certificate if you do not have a Practice Supervisor identified.

You will not be able to deliver patient care and your Certificate of Registration will have a restriction on it which will identify that you cannot deliver patient care.

• supervisor
• provisional-practice

There is an application fee of $114, which is taken at the time you apply. There is an additional fee of $85, which is taken once your application has been processed.

• provisional-practice

Yes. As of April 2017, your Practice Supervisor must currently hold an Independent Practice Certificate and have held the Independent Practice Certificate for the last three years in Ontario.  

Review the Supervision Requirements Summary Table for more information. 

• practice-supervisor

Our processing time for all applications is 15 days. This includes a review of the application to ensure you meet all the requirements. This part of the review could take longer if your application is incomplete.

Also, if there are concerns about your application, you may be referred to the Registration Committee for another review. This process can take up to 60 days. In fairness to all applicants, there is no fast track or expedited application process.

Note: An incomplete application will delay the processing times.

• application-process
• provisional-practice

Email the College at registration@collegept.org to provide the name and certificate of registration number of your proposed Practice Supervisor. The Registration team will review the proposed Practice Supervisor to ensure that they meet the requirements. If the Practice Supervisor is approved, the Supervisor will receive an e-mail instructing them to log into the Online Member Portal to sign a Supervision Agreement. 

If your proposed Practice Supervisor is not approved, the College will send you an email asking you to find a new proposed Practice Supervisor.

Remember: You are not permitted to practice until your Practice Supervisor is approved.

• practice-supervisor

Yes, a Physiotherapy Resident can roster for any authorized activity or controlled act that the person was educated to perform, as long as:

- The education included a theoretical component (learning, for example, about risks, contraindications)

- The education included a practical component (such as practice on other course participants)

- The education included an evaluation component of your knowledge (theory)
and skills (practice). 

- The Practice Supervisor is rostered to perform the same activities.

• -rostering
• authorized-activities

• supervisor
• pt-resident

- The College had no role in making the decision to change the funding for physiotherapy services in Ontario. Funding issues do not fall within our mandate.

- After the announcement was made about the funding changes, the College engaged in discussions with the Ministry of Health and Long Term Care and a variety of other partners in the health care system (including the OPA and the DPCA), to discuss such things as the College’s expectations with respect to communicating with patients, transfer of care and privacy requirements.

- Our objective is to help you navigate this challenging transition in the best possible way for patients.

• physiotherapy-services
• funding
• ministry-of-health

• Patients who are currently receiving in-home physiotherapy services

  (including a retirement home setting) and who wish to continue to access publicly funded services such as 1:1 physiotherapy care, falls prevention programs, or exercise classes may all be transferred to their local Community Care Access Centre (CCAC) by their current PT.

• To find the local CCAC by postal code visit:

  h†p://www.ccac-ont.ca/Locator.aspx?EnterpriseID=15&LanguageID=1&MenuID=46

• The CCAC will be assuming responsibility for providing ongoing care or transitioning the patient to the appropriate care setting as determined through assessment.

• ccac
• community-care-access-centre
• physiotherapy-services

- If the CCAC requests this information, you should provide it. This is because the CCAC has responsibility for all patients in their region.

- If the CCAC does not require it, or requires something simpler (such as a patient list) you should provide the information.

• ccac
• community-care-access-centre
• physiotherapy-services

The transfer summary should provide a clear picture of the patient’s condition and ongoing care needs by providing an overview of the care received, the patient’s current status, and recommendations for future care. Enough information should be included to allow the new care provider to take over and continue to provide care to the patient.

• ccac
• community-care-access-centre
• physiotherapy-services

With the anticipated changes we recognize that the timelines are tight. We ask that you do your best to provide information in a reasonable timeframe. Please don’t wait until the last minute.

• ccac
• community-care-access-centre
• physiotherapy-services

- If a patient no longer requires care, that patient should be advised their treatment is being discontinued.

- If a patient requires ongoing care, you may inform, the patient that his or her care will automatically be transferred to their local CCAC (unless they refuse the transfer) and that a summary of his or her condition, care and future needs will be provided to the CCAC. The patient should also be informed that the CCAC will use the transfer summary to assist with assessing and ensuring patients receive appropriate ongoing care such as 1:1 physiotherapy care, falls prevention programs, or exercise classes.

- You may wish to have a discussion with your patients about their options. However, please note that if you transfer all patients to the CCAC as described above, it is not a requirement to discuss options. This is a unique situation and does not vary the usual expectations on patient discharge in any other circumstance.

- If you wish to discuss the options with your patients, we recommend that you provide them with a copy of the options form h†p://www.collegept.org/Assets/ohip/PT_Treatment_Op- tions_Form130711.pdf. If the patient does not want to access publicly funded services provid- ed by the CCAC, a transfer summary should not be provided to the CCAC.

However, you should retain a copy of the options form in the patient’s chart to record the discussion that took place. This form has been created for PTs by the Designated Physiotherapy Clinic Association (DPCA) and the College.

- View the Physiotherapy Treatment Options form document at h†p://www.collegept.org/Assets/ohip/PT_Treatment_Options_Form130711.pdf co-developed by the College and DPCA. The document can be downloaded and provided to patients.

• physiotherapy-treatment-options-form
• dpca
• designated-physiotherapy-clinic-association

- The form is intended to help to guide your discussion with patients or their decision-makers.

- You may wish to distribute it to your patients.

- We recommend that you use it to document any conversation that you have about options, date and initial it and keep it in the patient’s chart.

• physiotherapy-treatment-options-form
• dpca
• designated-physiotherapy-clinic-association

If the patient does not want to access publicly funded services provided by the CCAC, you do not need to provide a transfer summary to the CCAC. However, a copy of the options form (h†p://www.collegept.org/Assets/ohip/PT_Treatment_Options_Form130711.pdf) should be kept in the patient’s chart to indicate the discussion that took place and the patient decided to decline.

• ccac
• collaborative-care

If the patient no longer needs to access ongoing physiotherapy care, exercise classes or falls prevention programs, treatment should be discontinued and a transfer summary should not be provided to the CCAC.

• collaborative-care
• funding

- Patients with ongoing care needs should be transferred to the CCAC, unless the patient indicates that he/she does not want services from the CCAC. If the patient so indicates, the CCAC will conduct assessments for transferred patients to ensure patients receive appropriate follow up care such as 1:1 physiotherapy care, falls prevention programs, or exercise classes.

- A transfer summary should not be provided to the CCAC. However, we recommend that a copy of the options form (http://www.collegept.org/Assets/ohip/PT_Treatment_Options_ Form130711.pdf) should be kept in the patient’s chart to record the discussion.

• ccac
• collaborative-care

The CCAC will use the transfer summary to assist with assessing and determining eligibility for appropriate ongoing care such as 1:1 physiotherapy care, falls prevention program, or exercise classes.

If a patient is determined by the CCAC as no longer requiring physiotherapy, the CCAC will discuss this conclusion with the patient and refer them as appropriate to other information, services or supports.

• ccac
• collaborative-care

No. Unless the patient has refused transfer to the CCAC (as described above) the CCAC, can be considered to be within the circle of care and explicit patient consent is not required.

For more information about ‘circle of care’ please visit the Office of the Information and Privacy Commissioner of Ontario website at www.ipc.on.ca

• ccac
• collaborative-care

In all other discharge situations, the expectation has not changed.

In this unique circumstance, patients who require ongoing care may be considered as being transferred (rather than discharged) to another provider, and the obligation to discuss options does not exist.

Patients may be made aware of the option to refuse publicly funded services but it is not a requirement that you have this discussion in this unique circumstance.

View the document (http://www.collegept.org/Assets/ohip/PT_Treatment_Options_ Form130711.pdf) co-developed by the College and DPCA summarizing the options for care. The document should be provided to patients if you will be discussing the option of refusing publicly funded care.

• discharge
• collaborative-care

- Patients should understand that there will be publicly funded care available through the CCAC such as 1:1 physiotherapy, group exercise classes, or falls prevention programs.

- It is up to each patient to determine whether he/she would prefer to decline the publicly available services and stay with his/her current provider on a private pay basis or to continue to receive care from both providers.

- Please ensure that a copy of the options form (http://www.collegept.org/Assets/ohip/PT_ Treatment_Options_Form130711.pdf) is kept in the chart of patients who refuse transfer to the CCAC.

• collaborative-care
• funding

- If you are an agent of the HIC, you will want to ensure that the HIC will maintain the records as required under the Personal Health Information Protection Act, 2004 (PHIPA) and that you and your patients will be granted access.

- The Office of the Information and Privacy Commissioner of Ontario website has information on the responsibilities of HICs related to storing personal health information at www.ipc.on.ca.

• record-keeping

While it is acceptable to rely on information provided by other health professionals, you should confirm that the information continues to be current and care can proceed safely so that the patient is not at risk.

• ccac
• collaborative-care

No, patients in LTC homes who have assessed need for physiotherapy services will continue to receive these services from a provider(s) as determined by the LTC home. The transfer of care to a CCAC applies only to patients residing in their own home, a retirement home, a senior’s building, or other congregate care setting (other than LTC).

• ccac
• long-term-care
• collaborative-care

• registration-committee

The registration requirements are in the College’s General Regulation Part III: Registration. Scroll to Part III. Should you have additional questions, don’t hesitate to contact the Registration team at registration@collegept.org. 

• registration

The Registration Committee is made up of physiotherapists and members of the public who have been selected by the Government of Ontario to represent the public.

The Committee’s role is outlined in the Health Professions Procedural Code, which is part 2 of the Regulated Health Professions Act.

The Committee’s key role is to review registration applications that do not meet the registration requirements. The Registration Committee reviews available information and decides whether the applicant should be issued a Certificate of Registration and if any terms, conditions or limitations are required on the person’s Certificate.

• registration-committee

The Registration Committee meets when a file is ready to be reviewed. It does not have a set schedule.

• registration-committee

After the College’s Registrar determines that an application needs to be referred to the Registration Committee, the applicant is contacted and informed that their application has been referred to the Committee for review. They are then provided with all of the necessary details in regards to timing, process and options.

The applicant is given a copy of all of the information that the Committee will be reviewing.

At this point, the person applying is given three choices:

1. They can continue with the Committee review process.
2. They can continue with the Committee review process and provide additional information to the Committee. They will be given 30 days to make additional submissions to the College.
3. They can decide that they no longer wish to continue with the application.

If the next Committee meeting date is known and is within 30 days, the applicant will be told that they have an opportunity to have their application reviewed at an earlier meeting (although 30 days has not passed). An applicant must notify the College in writing if they would like to waive their 30-day submission period.

The Committee’s decision will be issued in writing as soon as possible after the meeting has occurred. The College aims to issue all decisions within 30 days of the Registration Committee meeting. 

The Registration team is available to answer any questions about the process. You can reach them at registration@collegept.org or at 1-800-583-5885 ext. 222.

View the Registrar Review and Referrals to the Registration Committee flowchart.

Registrar Review Flowchart

• registration-committee

The Registration Committee only reviews files. Applicants are not permitted to attend the Committee meeting in person. They are encouraged to provide any helpful additional information before the meeting in a written format.

• registration-committee

It is helpful that the Committee clearly understands the circumstances surrounding an application. A written letter is often helpful. Additional information or evidence to support the application can assist the Committee in its decision making.

• registration-committee

The Committee has different options to manage a registration application. They can:

1. Direct the Registrar to issue a Certificate of Registration.
2. Direct the Registrar to issue a Certificate of Registration if the applicant successfully completes examinations or is approved by the Committee.
3. Direct the Registrar to issue a Certificate of Registration if the applicant successfully completes additional training specified by the Committee.
4. Direct the Registrar to impose specified terms, conditions and limitations on the applicant’s Certificate of Registration.
5. Direct the Registrar to refuse to issue a Certificate of Registration.

• registration-committee

Applicants can request a review of the Committee’s decision by the Health Professions Appeal and Review Board. Applicants are provided with information about the review process when they are issued the Committee’s formal decision.

• registration-committee

You can learn more about the types of cases the Board considers and the outcomes on the CanLII website. CanLII is a database of legal decisions.

• -hparb
• registration-committee

• specialty-title

• specialty-title

• specialty-title

• specialty-title

• specializataion

• specializataion

• PISA
• Professional-Issues-Self-Assessment
• what-is-PISA

The PISA exercise is available on February 1, 2024.

You can access PISA through the PT Portal.

Enter your email address (the one you use to receive College communications) and your password. There’s a “Forgot your Password” option if you’ve forgotten it. Once you’re signed in, you will see a PISA section in the menu on the left. From there, you will see your PISA for the current year, which includes a link to complete it.

If you have any issues signing into the PT Portal, please contact us at PISA@collegept.org or call 416-591-3828 ext. 222 or 1-800-583-5885 ext. 222.

Access the PT Portal

• PISA
• Professional-Issues-Self-Assessment

• PISA
• Professional-Issues-Self-Assessment

• -pt-students
• PISA
• Professional-Issues-Self-Assessment

• -jurisprudence
• PISA
• Professional-Issues-Self-Assessment

• PISA
• Professional-Issues-Self-Assessment

• PISA
• Professional-Issues-Self-Assessment

You are however required to complete it by March 31, 2024. If you do not complete it you could be referred to the Inquiries, Complaints and Reports Committee.

• PISA
• Professional-Issues-Self-Assessment

Yes, it is. You will be given the option to choose English or a French in the top right corner of the screen once you log into PISA in the PT Portal.

• PISA
• Professional-Issues-Self-Assessment

• PISA
• Professional-Issues-Self-Assessment

• PISA
• Professional-Issues-Self-Assessment

• PISA
• Professional-Issues-Self-Assessment

• PISA
• Professional-Issues-Self-Assessment

• PISA
• Professional-Issues-Self-Assessment

The legislation* defines sexual abuse of a patient as:

(a) sexual intercourse or other forms of physical sexual relations between the regulated health care provider and the patient,

(b) touching, of a sexual nature, of the patient by the regulated health care provider, or

(c) behaviour or remarks of a sexual nature by the regulated health care provider towards the patient.

It does not include touching, behaviour or remarks of a clinical nature appropriate to the service provided.

*The purpose of the provisions of the legislation with respect to sexual abuse of patients by members is to encourage the reporting of such abuse, to provide funding for therapy and counselling in connection with allegations of sexual abuse by members and, ultimately, to eradicate the sexual abuse of patients by members.

• mandatory-report

• mandatory-report

Failure by a person to make such a report where required may result in prosecution and upon conviction a fine up to $25,000 for a first offence and up to $50,000 for a subsequent office. If the reporter is a regulated healthcare provider, their respective College may also take action.

Where a facility fails to file a mandatory report where required to do so, failure to make such a report may result in prosecution and upon conviction a fine up to $50,000 for a first offence and up to $200,000 for a subsequent office.

• mandatory-report

• mandatory-report

Yes, you should make every effort to advise the patient that you must make the report before you submit it.

You should include the patient’s name but ONLY if you have their written consent to do so.

• mandatory-report

• mandatory-report

Yes, you still have a professional obligation to report as an individual even if your employer is filing a report. You might have additional information and it ensures the incident does in fact get reported.

• mandatory-report

After a report is filed, a College staff member will contact you within one week to clarify and ask for any additional information.

The Office of the Registrar will review the information to determine if additional investigation is required. Your involvement is not needed at this stage.

The results of the investigation will be considered by College’s the Inquiries, Complaints and Reports Committee (ICRC). The ICRC is comprised of representatives of the public and the profession. You will not be involved in the ICRC’s deliberations.

If the case goes to a Discipline Hearing, you may be asked to testify.

• mandatory-report

The report needs to in writing and should include:
a. the name and contact information of the person filing the Report
b. the name of the regulated health care provider who is the subject of the Report
c. an explanation of the alleged sexual abuse
d. the name of the patient (with written consent of the patient or substitute decision-maker)

• mandatory-report

• mandatory-report

• mandatory-report

• mandatory-report

• mandatory-report

The physiotherapist will have the opportunity to respond to the report in writing before the ICRC makes any final decision on a matter. The physiotherapist may also be asked to meet with an investigator. 

• mandatory-report

• mandatory-report

A physiotherapist’s certificate of registration may only be revoked after a hearing as a result of a finding made by either the Discipline Committee or the Fitness to Practice Committee.

• mandatory-report

• mandatory-report

• mandatory-report

• mandatory-report

• record-keeping

• record-keeping

• record-keeping

• record-keeping

• record-keeping

• record-keeping

• record-keeping

• record-keeping

• record-keeping

• record-keeping

• record-keeping

• charting
• record-keeping

• record-keeping

• record-keeping

• invoices
• record-keeping

• record-keeping

• confidentiality
• record-keeping

- The patient or their authorized representative. Patients and anyone to whom they give consent should be able to access the record throughout the retention period.

- The care providers within the "circle of care." Circle of care is not a defined term under the Personal Health Information Protection Act (PHIPA). It is a term used to describe Health Information Custodians (HICs) and authorized agents who are permitted to rely on an individual’s implied consent when collecting, using or disclosing personal health information to provide direct health care. For more information about circle of care, please visit the Office of the Information and Privacy Commissioner of Ontario website.

- An authorized assessor or investigator from a College established under the Regulated Health Professions Act (RHPA). Authorized investigators, assessors or representatives of the College of Physiotherapists of Ontario, as well as authorized investigators from another College established under the RHPA are permitted to access patient records in order to fulfill their obligations under the RHPA.

• confidentiality
• record-keeping

- Physical security (locked file cabinets, restricted office access, office alarm systems)

- Technological security (password protection, encryption, virus protection, firewalls)

- Administrative controls (security clearances, access restrictions, staff training and confidentiality agreements)

• confidentiality
• record-keeping

• record-keeping

1. Find out who the health information custodian (HIC) is in your organization. If you are not the HIC for your clinic, report the loss to the HIC. Hospitals, primary care teams, long-term care homes, pharmacies and community agencies are all considered HICs.

2. Once reasonable attempts have been made to locate the file, the HIC has a duty to notify the patient at the first ‘reasonable opportunity’ that the file has been lost.

3. You and the HIC should determine whether the privacy policies and processes of the organization were followed.

4. Next, the HIC must determine if this is a one time occurrence or if it is part of a pattern of errors, what the impact on the patient could be, and whether the loss of a record could happen again. Make note of the findings of the review.

Not all privacy breaches need to be reported to the Information and Privacy Commissioner of Ontario. If the lost chart is a one time occurrence, was not intentional and not a pattern, the matter can be internally managed. Debrief the issues with your team. Share the lessons learned so that you can build a positive culture around privacy safeguards in your workplace.

5. All professionals must be diligent in scanning, storing and transferring records. The HIC must ensure that there are policies and processes in place to protect patient’s health records and that all staff are aware of necessary steps to follow if there is a loss or breach of a patient’s information.

• record-keeping
• health-information-custodian

Patient consent is required before releasing information to another person – except in certain circumstances (for example, in an emergency). In some cases, consent must be expressly obtained and in other cases it can be implied or assumed. 

• privacy
• record-keeping

Express consent is required where personal health information is disclosed to a person who is not a health information custodian (such as a police officer) or it is disclosed for a purpose other than providing health care (for example, fundraising or marketing).

• consent
• record-keeping
• personal-health-information

Implied consent means the patient's behaviour implies that they consent (for example, a patient rolls his shirt sleeve up and presents his arm for your examination or when a client answers questions about his or her health history on an intake form), or the situation is such that consent can be assumed (for example, to provide ongoing health care). 

Health professionals can assume that they have an individual’s consent to collect, use or disclose personal health information for the provision of health care if the following conditions are met:

• The information was received from the individual (or substitute decision-maker), or another health information custodian.

• The information is collected, used or disclosed for the purpose of providing health care to the individual.

• If information is being disclosed, it must only be disclosed to another health information custodian.

• The individual has not withheld or withdrawn consent.

This is commonly referred to as sharing personal health information within the circle of care.

• consent
• privacy
• record-keeping
• personal-health-information

Consent is not required in the following circumstances:

- In an emergency

- If there is a significant risk of serious bodily harm

- In the context of a legal proceeding if the custodian or agent is a party or witness

- Records are released to a regulatory College (for example, in the context of an investigation of a complaint)

• consent
• privacy
• record-keeping
• personal-health-information

No. Individuals may consent verbally. But you should document in the individual’s health record that verbal consent was obtained.

• consent
• privacy
• record-keeping
• personal-health-information

Under the health privacy laws, patients can withhold or withdraw their consent to the collection, use or disclosure of their personal health information. They can also provide express instructions to not to use or disclose their personal health information (or put it in a lock box). This includes:

- Not collecting, using or disclosing a particular item of information (for example, a diagnosis).

- Not collecting, using or disclosing their entire health record.

- Not disclosing any personal health information to a particular person or group.

Although it is up to the patient to decide what (if any) personal health information to lock, and to whom the lock should apply, you should discuss with the patient how locking personal health information might affect their health care.

IPC Lock Box Fact Sheet

• consent
• privacy
• lock-box
• personal-health-information

1. Report the breach to the Health Information Custodian (HIC).

2. Follow the privacy breach protocol and attempt to locate the lost file or contain the privacy breach.

3. The HIC must notify the patient of the privacy breach, the steps taken to contain the breach or locate the list file, and the fact that they may make a complaint to the Information and Privacy Commissioner of Ontario.

4. You and the HIC should determine whether the privacy policies and processes of the organization were followed.

5. Determine if this is a one-time occurrence or if it is part of a pattern of errors, what the impact on the patient could be, and whether the breach could happen again. 

6. Document the findings of the review.

7. Notify the Information and Privacy Commissioner of Ontario if the breach meets their reporting threshold. If the loss or breach is a one-time occurrence, was not intentional and not a pattern of errors, the matter can likely be internally managed.

8. Debrief the issues with your team. Share the lessons learned so that you can build a positive culture around privacy safeguards in your workplace.

• privacy-breach
• privacy
• health-information-custodian
• privacy-commissioner

If you are the Health Information Custodian (HIC) you must can either retain the records and store (and later dispose of) them safely, or transfer custody of the records to a new HIC.  

You must notify individuals when you are transferring their health records to a successor.

IPC - Avoiding Abandoned Health Records

• privacy
• retiring
• leaving-a-practice
• health-records

Group practices should have formal written agreements in place that identify the custodian and obligations of each person when there is a change in practice.

• privacy
• health-information-custodian
• group-practice

• privacy
• personal-health-information
• privacy-commissioner
• record-storage

Email offers many benefits, but it also poses risks to the privacy of individuals and to the security of personal health information. Before using email to communicate, you should evaluate the risks and take steps to ensure that personal health information is protected from theft, loss and unauthorized use or disclosure.

IPC - Email Fact Sheet

• communication
• privacy
• personal-health-information

You can rely on the patient’s implied consent if:

• The information was received from the patient (or substitute decision-maker) or another health information custodian.

• The information is collected, used or disclosed for the purpose of providing health care to the individual.

• If information is being disclosed to another health information custodian.

• The individual has not withheld or withdrawn consent.

• consent
• privacy
• personal-health-information

No, but it's a good learning opportunity for staff. As the designated Health Information Custodian (HIC) you must first determine that the loss or unauthorized use or disclosure of personal health information is significant after considering all relevant circumstances. You must consider whether the personal health information is sensitive, whether the loss or unauthorized use or disclosure involved a large volume of personal health information or many individuals’ personal health information and whether more than one HIC or agent was responsible. If you determine that the access was not intentional, significant or part of a pattern then a report does not have to be made.

Remember that HICs are now required to report statistics relating to health privacy breaches annually to the Information and Privacy Commissioner of Ontario so keep a list of any potential privacy breaches. The online statistics submission website will be opened each year for health information custodians across Ontario to submit their statistics.

• privacy
• record-keeping
• health-information-custodian
• privacy-commissioner

1. You have relevant records

2. The records would help locate a missing person

3. Time is sensitive and the missing person would be harmed or the records destroyed if not produced immediately 

• police
• privacy
• record-keeping

Yes, a patient can request a copy of their electronic health record. If a patient requests a copy of his or her record, a copy should be provided within a reasonable time. A fee may be charged to recover costs but should be reasonable.  Ideally this fee should be included on the fee schedule at your clinic.

Before using email to send a record, you should evaluate the risks and take steps to ensure that personal health information is protected from theft, loss and unauthorized use or disclosure. Custodians should use encryption for emails to and from patients that contain personal health information. This includes by encrypting or password-protecting document attachments and sharing passwords separately through a different channel or message. If the use of encryption is not feasible, custodians must determine if the use of unencrypted email is reasonable in the circumstances after considering all relevant factors, including the sensitivity of the information, the purpose of the transmission, and the urgency of the situation.

(Please see IPC’s Fact Sheet: Communicating Personal Health Information by Email.)

Practitioners should always consider whether it is necessary to store personal health information on a mobile device (such as a USB key) or whether an alternative, such as de-identifying the information or accessing the information through a secure remote connection, would suffice.  If it is necessary to store personal health information on a mobile device, the information must be secured using “strong encryption.” Password protection is not enough. 

The Information and Privacy Commissioner of Ontario has stated that if personal health information on a mobile device is appropriately encrypted, the loss or theft of that device would not constitute a privacy breach.

• electronic-records
• record-keeping

• paper-records
• electronic-records
• record-keeping

• paper-records
• electronic-records
• record-keeping

• record-keeping
• storage

• record-keeping
• storage

• record-keeping
• disposal

Clinical and financial records must be retained for at least 10 years from the later of the following two dates: 

• the date of the last patient encounter, or
• the date that the patient reached, or would have reached 18 years of age.

• record-keeping
• disposal

• record-keeping
• disposal

You are required to:

• Keep records of all breaches.
• Determine if the information is significant after considering all relevant circumstances, including whether the personal health information is sensitive, whether the loss or unauthorized use or disclosure involved a large volume of personal health information or involved many individuals’ personal health information.
• Be prepared to report significant privacy breaches to the commissioner under Personal Health Information Protections Act 2004 (PHIPA).
• As of March 1, 2019, health information custodians will also be required to provide an annual report to the Information and Privacy Commissioner setting out the number of times in the preceding calendar year, personal health information in the health information custodian’s custody or control was stolen, lost, used without authority, and/or disclosed without authority. For custodians to prepare for this reporting requirement, they must start tracking their privacy breach statistics as of January 1, 2018.
  
   

Privacy resources: 

Information and Privacy Commissioner of Ontario

Personal Health Information Protections Act 2004 

Personal Information Protection and Electronic Documents Act 

IPC Health Privacy Breach Notification Guidelines

• privacy-breach
• health-information-custodian
• lost-records

An individual has "reasonable grounds" to believe that you may be incompetent, incapacitated or have sexually abused a patient.

• mandatory-reports

Incompetence means the physiotherapist displays a lack of knowledge, skill or judgment of a nature or to an extent that demonstrates that the physiotherapist is unsafe to continue to practice or that the physiotherapist's practice should be restricted.

• mandatory-reports
• professional-misconduct
• employers

• mandatory-reports

• mandatory-reports

• mandatory-reports

• mandatory-report
• employers
• revocation

• Take no further action
• Issue, advice and/or recommendations to the physiotherapist
• Require the physiotherapist to take part in a initiatives to improve your practice
• Issue a caution
• Make health related inquiries if you are suffering from a health condition which could put patients at risk. This could result in a referral to the Fitness to Practise Committee for a hearing 
•  Refer the matter to the Discipline Committee for a hearing

• mandatory-reports

• mandatory-reports

• mandatory-reports

• mandatory-reports

The following decisions are available to the public and appear on the physiotherapist’s record:

• Cautions
• SCERPS (remedial activities e.gs include but not limited to working with a coach, or taking a specific course)
• Undertakings (remedial activities, practice restrictions and resignations)
• Referrals to Discipline Committee
• Referrals to the Fitness to Practice Committee

• mandatory-reports

• mandatory-reports

• mandatory-reports

• mandatory-reports

• mandatory-reports

After an investigation, the Inquiries Complaints and Reports Committee may do the following:

• Take no further action
• Issue, advice and/or recommendations to the physiotherapist
• Require the physiotherapist to take part in a remedial activity to improve their practice
• Issue a caution to the physiotherapist
• Make health related inquiries if the physiotherapist is suffering from a health condition which could put patients at risk. This could result in a referral to the Fitness to Practise Committee for a hearing 
• Refer the matter to the Discipline Committee for a hearing

• outcomes
• mandatory-reports

The report should include:
o the name and contact information of the person filing the report;
o the name of the physiotherapist who is the subject of the report;
o an explanation of the concerns that have been identified

Failure to make such a report where required may result in prosecution and upon conviction a fine of up to $200, 000. If the individual is a regulated health care provider, their regulatory College may take further action against them.

A physiotherapist’s certificate of registration may only be revoked as a result of a finding made by either the Discipline Committee or the Fitness to Practice Committee.

However, in rare circumstances the physiotherapist can be temporarily suspended or have terms, conditions or limitations imposed on their certificate of registration through an Interim Order. This will only be considered in cases where immediate action is required to protect patients.

The ICRC can make any of the following decisions:

• Take no further action
• Issue advice and/or recommendations to the physiotherapist
• Require the physiotherapist to take part in remedial activities to improve their practice
• Issue a caution to the physiotherapist
• Make health related inquiries if the physiotherapist is suffering from a health condition which could put patients at risk. This could result in a referral to the Fitness to Practise Committee for a hearing
• Refer the matter to the Discipline Committee for a hearing
• Effective July 1, 2015, the following decisions will be made available to the public:

• Cautions
• SCERPS and Undertakings (remedial activities, resignations, practice restrictions)
• Referrals to the Discipline Committee
• Referrals to the Fitness to Practice Committee

• mandatory-reports

• employer
• mandatory-reports

• employer
• mandatory-reports

• specialty-designation
• titles
• record-keeping

• specialty-designation
• titles

• specialty-designation
• titles

No. You cannot use the title “Physiotherapist” or “ Physiotherapy Resident” or bill for physiotherapy services using the title PT when providing treatment to an animal.

The physiotherapist title is protected under the Regulated Health Professions Act to provide care to humans. The only way professionals can provide rehabilitation services to animals is under the direction and supervision of a veterinarian.

• titles
• fees-and-billing

• specialty-designation
• titles

• specialty-designation
• titles

• specialty-designation
• titles

• specialty-designation
• titles

• specialty-designation
• titles

• Cardiovascular & Pulmonary
• Clinical Electrophysiology
• Geriatrics
• Neurology
• Oncology
• Orthopaedics
• Pediatrics
• Sports
• Women’s Health
• Wound Management

• specialty-designation
• titles

• specialty-designation
• titles

• Patients
• physiotherapy
• cleaning-guidelines
• electrodes
• physiotherapist
• physical-therapist

Documenting the inspection, maintenance and servicing of physiotherapy equipment provides evidence that the necessary steps have been taken to ensure that equipment is safe for patient use.

You should take reasonable steps to ensure that the equipment used in clinical practice is properly maintained and calibrated according to manufacturer recommendations and that appropriate infection control procedures are in place. See the Infection Control and Equipment Maintenance Standard.

Even if you do not have direct control over the maintenance of equipment, for example, your employer is responsible; you are expected to take reasonable steps to ensure the safety of the equipment.

• Patients
• physiotherapy
• safety
• records
• equipment-maintenance

You must have written evidence that routine inspections of the equipment you use have been performed. The rigour (and frequency) of the inspection and maintenance protocol will vary with the riskiness of the equipment.

The College does not provide a specific timeline for the inspection of equipment used in physiotherapy interventions. However, it is recommended that you follow the manufacturer’s guidelines or best practice measures to ensure that the equipment is functioning correctly. Consider looking at Health Canada’s website. It is your responsibility as a physiotherapist to understand the risks of the equipment you use on patients.

Have a look at the Infection Control and Equipment Maintenance Standard that provides a list of all of the expectations PTs are expected to follow.

If in doubt, get in touch with the Practice Advisor at 647-484-8800 or 1-800-583-5885 or advice@collegept.org.

• Patients
• physiotherapy
• Health-Canada
• physiotherapist
• equipment-inspection
• physical-therapist

Think about what might reasonably go wrong with the equipment and have a plan to deal with the risk. For example, in addition to an annual review, each PT would want to visually inspect a walker or cane before providing it to a patient to ensure things like the rubber tips and hand grips are in good condition and if there are any nuts or bolts, that they are not loose. The PT must ensure the equipment is properly cleaned between each patient use.

Be sure to refer to the Infection Control and Equipment Maintenance Standard.

If in doubt, get in touch with the Practice Advisor at 647-484-8800 or 1-800-583-5885 or advice@collegept.org.

• Patients
• physiotherapy
• physiotherapist
• physical-therapist
• walker
• cane
• inspection

It is the physiotherapist's responsibility to ensure that the equipment they use to provide patient care is adequately maintained and safe.

A PT must ensure there is a written process for routinely reviewing the maintenance and safety of the equipment they use, and be able to demonstrate that they did the review. The maintenance may be done by another trained individual, but the physiotherapist needs to ensure that the review was done and know the date that is was completed.

Review the Infection Control and Equipment Maintenance Standard for more information.

• physiotherapy
• equipment-maintenance

PTs are expected to maintain the patient’s confidentiality of their health information. Discuss with the patient that you want to involve other members of their team in their care and get their consent to do so. However, if you have reasonable concern that the patient or the public is at risk of significant harm and the patient has not provided consent to share their health information, privacy laws have caveats allowing health care providers to disclose the information.

If you believe your patient is having suicidal thoughts consider the following:

- You might be the only person the patient feels comfortable disclosing this information to, do not ignore the comments. 

- You should stop treatment and be empathetic. e.g. I’m really concerned about your safety.

- Probing questions can help determine the patient’s level of risk – gauge responses accordingly. e.g. Will the patient follow up with their Dr. or is there a need to alert 911?

- Be ready to connect them to resources. Offer hotline numbers or offer to call together with the patient, provide rapid access service locations. 

- Reach out to an emergency contact if needed. 

Additional Resources:

• Personal Health Information Protection Act (PHIPA)
  
• Information and Privacy Commissioner
  
• Disclosure of Information Permitted in Emergency or other Urgent Circumstances
• Centre for Addiction and Mental Health Resources
• Crisis Resources

• physiotherapist
• unsafe-driver
• duty-to-report
• medical-condition
• visual-impairment
• cognitive

• patient
• sexual-abuse
• physiotherapist
• duty-to-report
• confidentiality
• imminent-harm

The cost is the same as the first time. The application fee of $100 CAD is taken when the College receives your application. If you are approved for a second certificate of registration, a fee of $75 CAD is taken before the certificate is issued.

Note that your application will have to be reviewed by the College’s Registration Committee who has the authority to refuse your request for a second certificate. 

Email the College at registration@collegept.org giving:

• The name of your proposed supervisor
• Certificate of registration number of your proposed supervisor, and
• The email of your proposed supervisor

The Registration team will review the proposed supervisor to ensure that they meet the requirements.

If the supervisor is approved, we will email them and ask them to sign a Practice Supervision Agreement in the PT Portal. Once they email us back the signed agreement, we will send you an email approving your request. This process can take up to 10 business days.

If your proposed supervisor is not approved, the College will send you an email asking you to find a new proposed supervisor.

Remember: You are not permitted to practice until your supervisor is approved.

Yes, you can roster for any authorized activity that you were educated to perform, as long as:

• Your education included a theoretical component (learning, for example, about risks, contraindications)
• Your education included a practical component (such as practice on other course participants)
• Your education included an evaluation component of your knowledge (theory)
  and skills (practice).
• Your practice supervisor is rostered to perform the same activities.

No. You must apply for a new Provisional Practice Certificate of Registration, which will need to be considered by the Registration Committee. You will have to show proof that you were not able to take the PCE because:

• you were ill or
• a family member was ill or
• a family member died.

If Canadian Alliance of Physiotherapy Regulators approves your application, you should apply for a second Provisional Practice Certificate of Registration. This certificate’s expiry will be based on the next Physiotherapy Competency Exam—Clinical you are registered for. 

Note: If your current certificate of registration expires while the CAPR is still reviewing your application, you cannot practice until you have a new certificate of registration. 

Visit the CAPR website

A conflict of interest arises when the PT’s professional judgment and decision making may be biased as the result of a competing financial interest (perceived, potential or real). Examples of conflict of interest are receiving or giving payment or gift cards for patient referrals.

Be sure to have a quick look at the Conflict of Interest Standard.

If in doubt, get in touch with the Practice Advisor at 647-484-8800 or 1-800-583-5885 or advice@collegept.org.

• physiotherapy
• boundaries
• professional-judgment
• Conflict-of-Interest

There are three steps to take:

1. Discuss and disclose the conflict with the patient before providing the service or product

2. Make the patient aware of any other practical alternatives

3. Document the discussion in the patient record

Definitely have a good look at the Conflict of Interest Standard.

Why not get in touch with the Practice Advisor at 647-484-8800 or 1-800-583-5885 or advice@collegept.org?

• physiotherapy
• boundaries
• physiotherapist
• Conflict-of-Interest

The College of Physiotherapists of Ontario does not have a specific rule about the use of incentives. Incentives may include things like discounts, rewards, gift cards, points programs or free parking or discounts for example. 

If you are a physiotherapist considering offering incentives or the practice where you work is considering offering incentives, you should reflect on the following things before making a decision. 

 •  Your professional judgment should not be compromised when offering incentives. 

 •  You should only provide care that is clinically indicated regardless of whether an incentive is offered.

 •  The cost of the incentive cannot be added to the cost of the service / invoice which is then provided to a third-party payor 

 •  You must protect patients who are vulnerable to unethical business practices when offering incentives

A conflict of interest of any kind (including the use of incentives) has the potential to compromise the trust that a patient has placed in their physiotherapist and, on a wider scale, the confidence that the public has placed in the physiotherapy profession. 

Offering incentives comes with risks. When making the decision as to what incentive you might offer patients you must ensure that incentives provided for patients’ benefits (things like free parking or a $10 discount on assessment) do not affect your clinical decision-making when recommending ongoing treatment. 

Incentives linked to ongoing care may present an opportunity for certain patients with high or unlimited extended health benefits, and low personal income, to be taken advantage of should you offer goods in exchange for physiotherapy services. Doing this would be inappropriate. At no time should a physiotherapist provide care based on the patient’s benefits rather than objective findings and clinical reasoning.

Although there is no specific rule related to incentives, it is imperative that you make your decisions after having reviewed the Advertising Standard, Fees, Billing and Accounts Standard and Conflict of Interest Standard when considering business models and introducing incentives into your practice. 

While the College does not have a list of specific incentives that may be appropriate or inappropriate you should be aware that third party payors may have different positions regarding the use of incentives. Any decision made by a third-party payor to delist a clinic or a physiotherapist based on the use of incentives is made independent of the College.

Resources: 

Advertising Standard

Fees, Billing & Accounts Standard

Conflict of Interest Standard

Code of Ethics

Professional Misconduct Regulation

Exploring the Practice of Offering Incentives (CHLIA)

No, this is giving a benefit to someone for your financial gain. Physiotherapists should avoid conflicts of interest, or the appearance of conflicts of interest. This is clearly outlined in the Professional Misconduct Regulation and the Conflict of Interest Standard.

• physiotherapy
• physiotherapist
• Conflict-of-Interest
• referrals

Yes, although remember PT’s should only recommend products or services to patients that are clinically indicated.  You should disclose the financial interest to the patient in advance, make the patient aware of any practical alternatives, and assure the patient if they choose an alternate supplier that care will not be affected. Document the discussions in the clinical record.

Be sure to re-read the Conflict of Interest Standard so you have a solid understanding of what the rules say.

Why not get in touch with the Practice Advisor at 647-484-8800 or 1-800-583-5885 or advice@collegept.org?

• physiotherapy
• physiotherapist
• Conflict-of-Interest

Obviously, any services recommended to the patients must be clinically indicated.

You must also:

- Disclose to the patient, in advance, that you have a financial interest in the business

- Make the patient aware of any other options for receiving the recommended services

- Assure the patient that if they choose another surgeon or RMT, it will not adversely affect their physiotherapy care

- Document the discussion in the patient’s record 

There are similar conflicts of interest obligations for the surgeon and RMT when referring patients to you. Be sure to check with the respective colleges to learn the details. 

• physiotherapy
• treatment
• massage-therapist
• Conflict-of-Interest
• business
• services
• surgeon

No, physiotherapists cannot offer benefits or rewards in exchange for positive reviews.

Consider the following three Standards:

The Conflict of Interest Standard states that PTs must recognize and manage situations that may result in a real, potential, or perceived conflict of interest. A PT is in a conflict of interest if their professional actions or decisions result in a benefit to them and are not in the best interest of the patient.

The College's Boundaries and Sexual Abuse Standard requires that physiotherapists always act in the patient's best interest to manage boundaries in the therapeutic relationship. Patients and others may perceive that they are being pressured or bribed to leave a positive review, which is not only unethical, but blurs those boundaries.

Additionally, the Advertising Standard requires that all advertising be true, accurate and verifiable. Patients may be encouraged to submit positive reviews based on the desire for a discount rather than their actual experience and opinion. 

Physiotherapists can solicit positive reviews in ways that do not cross boundaries or present a potential conflict of interest. Consider inviting patients who have had a positive experience to leave a review by putting up a sign in your clinic or including the information in a newsletter that goes out to patients who have signed up to receive it.

• Conflict-of-Interest
• gift-card

Applying for an Independent Practice Certificate is completed online.

Access the PT Portal on the College’s website to apply for an Independent Practice Certificate.

• Choose “I am applying for a new Certificate of Registration with the College—Independent Practice, Provisional Practice or Courtesy”

Describe the behaviour to the patient objectively and tell them why it is a problem to you and perhaps other patients at the clinic. During the discussion outline your expectations for behaviour and make sure they understand the consequences of not changing their behaviour. Continue to monitor the situation and follow up with the patient. If a professional boundary has been breached and all reasonable steps have been taken to manage it, you may choose to stop treatment

No, you must continue to treat them.

• Patients
• physiotherapists
• treatment
• cigarettes
• refusing-care
• providing-care
• refuse

• consent
• patient
• treatment
• physiotherapist
• assessment
• refusing-care
• providing-care
• capable
• permission

It may not be necessary to make a full note on every patient visit.

When a physiotherapist has documented a comprehensive assessment, there is a clear treatment plan, and the patient’s condition has not yet changed from the last appointment, an attendance record (documenting that the patient has come to the appointment), it may be enough. An attendance record could just be a check-mark on a set date indicating the patient came for treatment or it may appear in a different way.

However, if the patient’s condition has changed or the therapy is modified there needs to be documentation of this change in the patient’s chart.

If you want a full picture of the patient’s attendance or overall treatment you should ask for the invoices (they can also tell you who provided care and when), the patient record, any exercise sheets or logs and/or a record of attendance which could be captured in the patient chart, on the clinic sign in sheet or in treatment logs.

• physiotherapist
• record-of-attendance
• assessment
• documentation
• insurers

We do receive reports from PTs who are concerned that their name and registration number have been used after they have left a practice setting.

Usually the PT finds out from a former colleague or because an insurer has initiated a claims verification audit. In most cases, the clinic is owned by someone who is not a regulated health care provider. We do not often hear of situations where the PT is still working at the practice and their name and registration number is being used without their consent.

The College works with the PT to assist them in deciding how to proceed. They are also advised to use the CHLIA and IBC tip lines.

You should know that PT registration numbers are no longer available in full on the Public Register. The partial number was introduced last year. This was to address the concern that this information could be accessed and used for improper purposes.

• public-register
• insurance-fraud
• registration-number
• employer
• physiotherapist
• insurers

Tele-rehabilitation is the provision of physiotherapy services at a distance, by an information or communication technology such as video conferencing, when an in-person visit is not possible. 

A patient can expect the same safe, effective, and ethical care as an in-person visit and the physiotherapist must comply with all regulatory requirements.  

Tele-rehabilitation may be appropriate if the patient cannot easily access an in-person visit due to a shortage of physiotherapy services available in the region where the patient lives or because of transportation or mobility concerns. Physiotherapists should use their professional judgment to determine if this model of care is the most appropriate available method to deliver physiotherapy care and that the patient is not exposed to any increased risk. Patients and physiotherapists alike need to recognize any limitations that tele-rehabilitation services present including privacy of personal health information, safety of the patient within the context of their home or work environment and the inability to perform a hands-on assessment and subsequent treatment. A physiotherapist may bill for tele-rehabilitation services and the rate is expected to be reasonable and professional within the context of the practice setting.

• billing
• treatment
• physiotherapist
• invoice
• telerehabilitation
• assessment

A Physiotherapy (or Physical Therapy or PT) Resident has a degree in physiotherapy, has successfully completed a written test of knowledge and is registered to take the next available clinical exam.

They have an experienced Physiotherapist supervising their practice, but PT Residents are registered with the College of Physiotherapists of Ontario, have liability insurance and are accountable for their practice.

They are permitted to assess and treat patients independently, and to bill for their services. Their registration is time limited. You can verify the status of a PT Resident on the College's Public Register. 

Public Register

• billing
• public-register
• registration-number
• supervision
• pt-resident
• physiotherapy-resident

No. It is never acceptable to bill in advance of providing the treatment.

Sometimes to make it easier for a client, the PT will provide services and then issue an invoice later. This would be permitted if all of the individual dates of service are listed.

Yes, a physiotherapist must provide an itemized account for services and/or products if the patient or a payer requests one, and it must be provided free of charge.

• billing
• treatment
• physiotherapist
• invoice
• itemized
• insurer

The College does not set the rates for physiotherapy care, including care provided by a physiotherapist assistant. The fees charged should be publicly available and a written fee schedule should be made available to the patient before they agree to receive physiotherapy care. Physiotherapists must ensure that fees are not excessive according to our rules.

Fees charged by physiotherapists may vary across Canada. Some PTs will invoice by the half hour or hour, while some bill in 15-minute blocks. We have seen some cases where billing is done by treatment modality. So, it could be that a PT charged less if a physiotherapist assistant provided the care, but this is not the norm.

• treatment
• physiotherapist-assistant
• physiotherapist
• fees
• insurer

No, physiotherapists are not permitted to sell memberships.

• insurance
• physiotherapist
• insurer
• memberships

No. In Ontario, physiotherapists are considered primary health care practitioners, so a referral from a doctor is not necessary. Although, sometimes an insurance company may require a doctor's referral.

• college
• ontario
• pt
• public-register
• employer
• physiotherapist
• physical-therapist
• registered
• clinic-owner
• hire-a-physiotherapist

• college
• ontario
• pt
• public-register
• employer
• physiotherapist
• physical-therapist
• find-a-physiotherapist
• clinic-owner
• hire-a-physiotherapist

• pt
• employer
• physical-therapist
• supervision
• physiotherapy-resident
• clinic-owner
• hire-a-physiotherapist
• pce
• physiotherapy-competency-exam
• working-with-physiotherapists

Yes, a Physiotherapy Resident can use their unique registration number for billing purposes.

• billing
• registration-number
• employer
• Billing-Number
• supervision
• pt-resident
• physiotherapy-resident
• clinic-owner
• working-with-physiotherapists

Yes, Physiotherapy Residents who have gained the competence to perform a controlled act may roster, but they may only perform controlled acts if their supervisor is also rostered.

• employer
• roster
• supervision
• pt-resident
• physiotherapy-resident
• controlled-act
• rostered
• training
• working-with-physioterapists

The government has not yet finalized the rules to allow physiotherapists to independently order x-rays and lab tests. We are not certain when this will happen. In the meantime, physiotherapists who have developed the competencies to do these activities can do so if an authorized healthcare provider (such as a physician) delegates their authority to the physiotherapist.

• physiotherapy
• scope-of-practice
• pt
• employer
• physiotherapist
• working-with-physiotherapists
• x-rays

Yes, if the PT has completed a comprehensive assessment of the patient, has assigned components of care to the PTA, and supervises the treatment provided, the physiotherapist can bill for the treatment. The physiotherapist must ensure that the PTA has the knowledge, skill, and judgment to deliver safe and competent care.

• billing
• pta
• pt
• employer
• physiotherapist-assistant
• physiotherapist
• supervision
• working-with-physiotherapists

Occasionally, physiotherapists are required to undergo practice assessments as part of the College’s Quality Assurance program. If a physiotherapist you work with is selected, they are required by law to participate and should receive your full support. Practice assessments take approximately one to three hours, can be face-to-face or via teleconference and must be completed in the physiotherapist’s workplace.

• pt
• physiotherapist
• working-with-physiotherapists
• employers
• quality-assurance
• practice-assessment
• professional-development

Employers or persons who operate facilities must file a mandatory report with the College in the following circumstances:

a) There are "reasonable grounds" to believe the physiotherapist may be incompetent, incapacitated or have sexually abused a patient.

OR

b) The physiotherapist has been terminated from their job or a partnership, a health profession corporation or association with the physiotherapist was dissolved, or for reasons of professional misconduct, incompetence, or incapacity.

OR

c) The physiotherapist’s employer intended to terminate them for reasons of professional misconduct, incompetence, or incapacity but the physiotherapist resigned.

• Reporting-Obligations
• incompetence
• physiotherapist
• incapacity
• professional-misconduct
• mandatory-report
• employers

Incapacity means the physiotherapist is suffering from a physical or mental condition or disorder that makes the physiotherapist unfit to continue to practice or to practice without additional safeguards.

• Reporting-Obligations
• pt
• employer
• physiotherapist
• incapacity
• mandatory-report
• working-with-physiotherapists

Incompetence means the physiotherapist displays a lack of knowledge, skill, or judgment of a nature or to an extent that demonstrates that the physiotherapist is unsafe to continue to practice or that the physiotherapist's practice should be restricted.

• Reporting-Obligations
• pt
• incompetence
• employer
• physiotherapist
• mandatory-report
• working-with-physioterapists

Professional misconduct means the physiotherapist fails to meet their professional obligations. These obligations are defined in legislation, regulation, the By-laws, or the standard of practice of the profession.

• Reporting-Obligations
• pt
• employer
• physiotherapist
• professional-misconduct
• mandatory-report
• working-with-physiotherapists

Employers must file a mandatory report within 30 days of learning of an incident, terminating employment or ending of the professional relationship with the physiotherapist, or receiving the physiotherapist’s resignation (if they resign while facing termination).

• Reporting-Obligations
• pt
• employer
• physiotherapist
• mandatory-report
• working-with-physiotherapists
• termination
• resignation
• reporting-timeframe
• reporting-deadline

The report should include: 

• the name and contact information of the person filing the report
• the name of the physiotherapist who is the subject of the report
• an explanation of the concerns that have been identified

• Reporting-Obligations
• pt
• employer
• physiotherapist
• mandatory-report
• working-with-physiotherapists

• Reporting-Obligations
• physiotherapists
• pt
• employer
• mandatory-report
• working-with-physiotherapists

Failure to make such a report where required may result in prosecution and upon conviction a fine of up to $200, 000. If the individual is a regulated health care provider, their regulatory College may take further action against them.

• Reporting-Obligations
• employer
• physiotherapist
• mandatory-report
• working-with-physiotherapists
• failure-to-report
• fines

The Office of the Registrar will determine if additional inquiries or a formal investigation is required. If a formal investigation is initiated, the physiotherapist will be provided with information from the investigation and will have the opportunity to respond. In addition, an investigator from the College may wish to meet with the physiotherapist.

The results of a formal investigation and the physiotherapist’s response will be provided to the Inquiries, Complaints and Reports Committee which is comprised of both members of the public and the profession. The Committee will not make a final decision on a matter without the physiotherapist having the opportunity to respond to the identified concerns.

• college-of-physiotherapists-of-ontario
• physiotherapists
• registrar
• investigation
• employer
• mandatory-report
• Inquiries-Complaints-and-Reports-Committee
• working-with-physiotherapists

The physiotherapist will have the opportunity to respond to the report in writing before the Inquiries, Complaints and Reports Committee makes any final decision on a matter. The physiotherapist may also be asked to meet with an investigator. 

• Reporting-Obligations
• employer
• mandatory-report
• working-with-physiotherapists

The physiotherapist and the College are the only parties involved in the process. As such the outcome of the process is not shared with the individual who submitted the mandatory report to the College. If the matter is referred to the Discipline Committee or Fitness to Practise Committee for a hearing, the College may ask the reporter to participate in the hearings process as a witness.

• Reporting-Obligations
• employer
• mandatory-report
• working-with-physiotherapists
• investigation-process

A physiotherapist’s certificate of registration may only be revoked as a result of a finding made by either the Discipline Committee or the Fitness to Practise Committee.

However, in rare circumstances the physiotherapist can be suspended or have terms, conditions or limitations imposed on their certificate of registration through an Interim Order. This will only be considered in cases where immediate action is required to protect patients.

• Reporting-Obligations
• employer
• physiotherapist
• mandatory-report
• working-with-physiotherapists
• investigation-process
• certificate-of-registration
• revoke
• revocation
• employing-physiotherapists

The Inquiries, Complaints and Reports Committee can make any of the following decisions:

• Take no further action.
• Issue advice and/or recommendations to the physiotherapist.
• Require the physiotherapist to take part in remedial activities to improve their practice
• Issue a caution to the physiotherapist.
• Make health related inquiries if the physiotherapist is suffering from a health condition which could put patients at risk. This could result in a referral to the Fitness to Practise Committee for a hearing.
• Refer the matter to the Discipline Committee for a hearing

Effective July 1, 2015, the following decisions will be made available to the public:

• Cautions
• SCERPS and Undertakings (remedial activities, resignations, practice restrictions)
• Referrals to the Discipline Committee
• Referrals to the Fitness to Practice Committee

• employer
• mandatory-report
• Inquiries-Complaints-and-Reports-Committee
• working-with-physiotherapists
• investigation-process
• remedial-outcomes

The timelines can vary quite a bit. Some investigations are quite detailed and extensive while others are relatively short. Matters are processed as quickly as possible while ensuring a balanced, fair, objective, and complete investigation. The Committee will not decide without the benefit of having full information.

• Reporting-Obligations
• employer
• mandatory-report
• working-with-physiotherapists
• investigation-process

• Reporting-Obligations
• employer
• mandatory-report
• file-a-complaint
• complaint-process
• Inquiries-Complaints-and-Reports-Committee
• working-with-physiotherapists
• make-a-complaint

The remote assessment should take approximately one hour. To be safe, we recommend that you schedule your time, so you are prepared to start the assessment five minutes before the scheduled start time and give yourself an extra 15 to 20 minutes after the one-hour mark. 

• practice-assessment
• remote-assessment

You and your assessor will connect by phone or video conference at the scheduled date and time of the remote assessment. The structure of the assessment is:

• Introduction: 5 minutes
• Behaviour-based interview questions: 50-60 minutes
• Closing: 5 minutes

• practice-assessment
• remote-assessment

• practice-assessment
• remote-assessment

When preparing for the remote assessment, it may be helpful to review the following College Standards and resources:

• Physiotherapist Essential Competencies
• Consent
• Infection Control and Equipment Maintenance Standard
• Collaborative Care Standard
• Boundaries and Sexual Abuse Standard
• Code of Ethics
• Communication Skills
• Controlled Acts and Restricted Activities Standard
• Working with Physiotherapist Assistants Standard

• practice-assessment
• remote-assessment
• how-to-prepare

No. The College does not share your assessment results with anyone. It is up to you to decide if you want to share your results with peers or your employer. The Quality Assurance Program does not provide the results to other College Committees such as Registration or the Investigations, Complaints and Reports Committee.

• employer
• practice-assessment
• remote-assessment
• results

If you are selected for an assessment, you can request a deferral under certain circumstances. In most cases, the Quality Assurance team can grant an extension or deferral. In other cases, the request must be decided by the Quality Assurance Committee.

College staff can issue an extension or deferral, on a case-by-case basis, in the following circumstances:

• Personal injury or illness of the registrant
• Injury or illness of a family member and the registrant is the primary caregiver
• Extenuating personal circumstances
• Not currently in practice due to parental leave or enrollment in a full-time education program
• Registrants who are the subject of an active professional conduct matter with the College

Extensions are provided for up to three months. Deferrals can be issued for up to one year, depending on the registrant’s situation. 

For an extension, the registrant continues the assessment process but the timelines to complete the process are extended. For deferrals, the registrant is taken out of the process and is notified when the deferral expires. Once the deferral is expired, the registrant must continue the assessment process.

You must submit your request for an extension or deferral in writing. Please email qualityassurance@collegept.org with your request including all relevant details.

• extension
• quality-assurance
• practice-assessment
• remote-assessment
• deferral

Yes. The College’s authority to do this comes from Sections 36 and 40 of the Regulated Health Professions Act, 1991 (the RHPA) and sections 83 and 83.1 of the Health Professions Procedural Code (the HPPC). Physiotherapists are legally required to cooperate with the College’s quality assurance program requirements, including access to patient records.

The RHPA and HPPC make it clear that the College’s right to access overrides all other confidentiality provisions. This duty to cooperate includes facilities and records maintained under any other legislation or authority, including public hospitals, Home and Community Care Support Services, long-term care facilities and the private sector.

However, we have noted that the wording in the HPPC is not specific enough to provide unequivocal advice on whether the College can require a health information custodian, who is not a physiotherapist, to provide a copy of the record.

• privacy
• confidentiality
• patient-record
• quality-assurance
• practice-assessment

No. Section 43. (1) of the Personal Health Information Protection Act permits health information custodians (HICs) to disclose personal health information to a regulatory College under the Regulated Health Professions Act (RHPA) for the purpose of administration and enforcement of the RHPA.

• consent
• privacy
• confidentiality
• patient-record
• quality-assurance
• practice-assessment

When assessment documents are ready to be shared with an assessor, a TitanFile channel is created by the Quality Assurance Team. Each physiotherapist’s assessment has their own channel created on TItanFile. Several TitanFile features ensure that assessment documents remain secure, private, and confidential.

These features include:

Read Only: The assessor added to the channel to access a PT’s patient records cannot post messages or add files to the channel.

Password Security: The Quality Assurance Team’s account password is changed every three months.

Channel expiration: The Assessor’s access to the channel is set to expire exactly one week after the scheduled assessment to coincide with the due date of the assessor’s final report.

Custom data retention: 30 days after a document channel has been deleted, it is permanently deleted from all TitanFile backup servers.

Two-factor authentication: The assessor upon creating a TitanFile account, will need to set-up two-factor authentication (2FA). Two-factor authentication is requested whenever the assessor accesses the assessment channel.

Limited viewer: The assessor is made a “limited viewer.” This means the assessor cannot download them on to their personal computer/device. Additionally, the assessor cannot print the files.

Audit logs: Notifications are sent to the Quality Assurance Team email inbox when a PT submits their patient files, as well as when the assessor accesses the documents in the assessment channel. All conversation and channel histories are downloaded once the physiotherapist’s assessment case file is closed.

• privacy
• confidentiality
• patient-record
• quality-assurance
• practice-assessment

The College uses a cloud-based Microsoft Dynamics database which includes an online members portal. All Microsoft cloud services undergo regular security analysis, and Microsoft tracks and publishes details around the various security metrics and standards.

Microsoft uses a set of industry standard security protocols for authentication and authorization. External users’ access to the College’s online members portal is managed using an authentication process through an external account. In order to create a portal account, an invitation code is sent to an identity provider (Gmail, Yahoo, etc.). The verification code sent by email establishes the identity of the user through the email account. If the user enters the correct verification code, then they can go on to complete their account setup. For new users (for example, new applicants), this procedure also creates a contact record in the College’s database. Portal users can only see information associated with their contact record.

For physiotherapists who already have a contact record in the College’s database, they must create their portal account using the email they have on record with the College, which allows the College to match the account to the correct record in the database. This ensures that registrants only have access to their own information.

• practice-assessments
• information
• privacy
• confidentiality
• quality-assurance
• delete
• store
• collect

• practice-assessments
• privacy
• confidentiality
• quality-assurance
• privacy-officer

• practice-assessments
• records
• privacy
• confidentiality
• quality-assurance
• assessor

The one de-identified patient record submitted by the physiotherapist will be reviewed and scored by the assessor assigned to them. The score will form part of the physiotherapist’s remote assessment report.

If the assessment report has to be reviewed by the College’s Quality Assurance Committee, then a copy of the record will be included as part of the comprehensive assessment information that will be provided to the Committee.

Any information collected through the Quality Assurance process is not shared with any other areas of the College in accordance with sections 83 and 83.1 of the Health Professions Procedural Code.

Physiotherapists are asked to submit a complete patient record. This means everything that is in the patient’s physiotherapy file, including: assessments, reassessments, progress notes, discharge report, financial record (if applicable), attendance tracking, copies of exercise sheets (if any) and notes completed by the physiotherapist assistant.

It is okay if the physiotherapy records include notes completed by other physiotherapists or other healthcare providers. The assessor is only looking at the notes of the member being assessed but the other notes will add context to the record as it is reviewed by the assessor.

De-identifying a patient record involves removing information that, either alone or with other information, identifies an individual. For example, a person’s name, date of birth, address, phone number, OHIP number, etc.

Where possible, instead of redacting the entire section or block of the record that contains identifying information, section or field titles should be left visible to indicate what information is contained in that section.

If your work site does not appear in the drop-down list, please search for Other as your Name of Work Site (it’s on the second page of results), and select it. You will then be able to provide your missing work site’s name, location and phone number.

Please note that this information will not appear on the Public Register until the College Registration Team has verified it. Once it has been verified you will receive an email letting you know that is now appears publicly.

• information
• physiotherapist
• employment
• update
• pt-portal

To update the address and contact details for workplace, you need to add an End Date (the day your location changed), as well as any other missing information and click Save at the bottom of the page.

Then click Create to add an employment record for your new location. Your start date should be the day your location changed.

Select your new location for your work site, or Other if your new location does not appear in the drop-down menu.

• information
• employment
• update
• site
• pt-portal
• workplace

No, you cannot. As the Public Register is updated in real time, your employment’s start and end dates cannot appear to be later than today’s date. If you are aware that you are starting a new job, or leaving a current one, please update your employment on the day it occurs or shortly after. Don’t forget you have an obligation to update it within 30 days of the change at the latest.

• public-register
• information
• employment
• update
• pt-portal

If your employer (the company that pays you) is different from your practice location (the physical location where you work), you must check this box and provide your employer’s information.

• information
• employer
• employment
• update
• pt-portal

While you may have more than one area of practice at a specific worksite, we only require and accept one. Choose the one you think is best.

• information
• employer
• employment
• update
• pt-portal
• worksite

If you are on leave from your employment you must update your employment information by adding an end date (this would be the date that you went on leave).

When you return from your leave, you should then add a new employment entry, with the start date being the day you returned to work.

Please also update your Current Employment Status on your profile page, if your new employment information has caused it to change (i.e. you were working in physiotherapy, but are now on leave).

• information
• employer
• employment
• update
• pt-portal

Any employment information that took place up to March 31, 2018 and earlier, no longer appears on the Public Register, or in the PT Portal for you to see. 

Please be assured we still have those records in our files. Please do not try to add any past employment that appears to be missing, if that employment ended on or before March 31, 2018.

• information
• employer
• employment
• update
• pt-portal

If you only deliver care at a patient’s home, you would answer No to this question.

• information
• employer
• employment
• update
• pt-portal

• Triaging, initial assessment (subjective and some objective components including outcome measures), ongoing assessments to monitor progress including use of objective assessment tools that are available in many software programs and apps.
• Exercise prescription, supervised therapeutic exercise and appropriate progressions
• Home-based modalities, including electrical stimulation and heat and cold applications, as long as the patient has the equipment at their home.
• Self-administered techniques such as soft tissue massage or frictions under the direction of the physiotherapist, including patient education on how to do and at what intensity.
• Support for self-management, education, coaching and reassurance for patients and for caregivers. This includes teaching patient’s families how to assist in performing stretches or guide home exercises.
• Assessment of how patients are functioning and adapting in their home environments, including assessment of fall risks and other functional activities of daily living assessments.
• Bracing, donning, removal and check in on fit and outcomes for bracing. 

Virtual practice is permitted by the College for all other physiotherapy care if the care provided (like any other care) meets all the College standards, and it is in the best interest of the patient. Virtual care is not new and was used by PTs before the pandemic.

Some physiotherapy may be delivered virtually in a group setting, but that does not exempt a physiotherapist from meeting all the College Standards and rules. You can see a list of those rules here.

Therefore, a physiotherapist must do things like:

• Discuss the privacy and confidentiality risks and the precautions taken with each patient.
• Get the patient's consent in the same way they would for an in-person assessment or treatment. In the case of virtual practice, they must be sure the patient understands explicitly how the assessment or treatment will work using technology.
• The PT must document the discussion they had with the patient in the patient's record.
• The Record Keeping Standard applies in the same way whether the care is delivered face-to-face, in a group, or virtually. The patient assessment, diagnosis, goals of the treatment and a treatment plan must be charted. The PT should make it clear in the patient's record and invoice if treatment was delivered virtually and in a group.
• The College cannot recommend physiotherapy fees. All costs must be transparent to the patient and have been agreed to before the service is provided. The invoice or patient record should indicate group treatment and that the treatment was delivered virtually.
• The decision as to whether something is covered by insurance, whether virtual and/or group therapy classes, is the decision of each insurance carrier.

Key take away:

If physiotherapy is delivered virtually, in a group or even one-on-one, all College standards must be met by the physiotherapist in the same way

Please, see some helpful FAQs about telerehabilitation posted on our website.

• patient-care
• long-term-care
• retirement-home
• virus
• corona
• urgent
• screening
• covid

In a health emergency such as the current pandemic, physiotherapists are valuable members of the health care team who may be asked to participate in activities that are outside their normal duties.

PTs may be asked to assist with mask fit testing or screening procedures. Some of the activities that physiotherapists may be asked to perform are considered controlled acts and require delegation by a practitioner who is authorized to perform them.

Recognizing these activities may not be common practice for PTs, they could only be done with adequate training on the procedures and if given the required personal protective equipment.

• physiotherapy
• long-term-care
• retirement-home
• virus
• corona
• covid
• emergency-measures

Yes, these are unprecedented times and the Government of Ontario is committed to ensuring that there are sufficient resources available in publicly funded settings to assist with the care of COVID-19 patients. In a health emergency such as the current pandemic, physiotherapists are valuable members of the health care team who may be asked to participate in activities that are outside their normal duties.

Some of the activities that physiotherapists may be asked to perform are considered controlled acts and require delegation by a practitioner who is authorized to perform them. Recognizing these activities may not be common practice for PTs, they should only be done with adequate training on the procedures and if given the required personal protective equipment.

Further direction about what you can and can’t be asked to do will be available from your employer or the various directions issued by the government. The College is unable to provide physiotherapists with a list as to what they should and should not be doing when deployed to a different position. With appropriate safeguards in place we would expect physiotherapists to be flexible during situations of health emergencies to assist the health care system manage increased demands.

There are a number of free resources and training courses available to physiotherapists during this time. View a list of online training and resources. 

• physiotherapy
• long-term-care
• retirement-home
• pandemic
• virus
• corona
• covid
• delegation
• redeploy

Consider the following:

1. Is it clinically appropriate based on each patient's needs or is an in-person visit required? 
2. Are there any physical, cognitive or sensory deficits that may make tele-practice unsafe or ineffective for a particular patient?  
3. Are you able to protect the safety of your patient’s personal health information? (Consider your and the patient’s location as well as the technology itself - make sure it is PHIPA compliant). 
4. If the patient is located in another province you must be registered to practice in that jurisdiction.
5. Do you have a plan in place to deal with potential adverse events such as patient medical emergencies, failure of the communication technology or environmental hazards?  
6. Ensure you have the patient's consent — have a discussion with the patient and discuss things such as the difference between in-person and tele-rehabilitation services, options to receive in-person care, the risks to the privacy of their health information and any safeguards in place to reduce these risks.  
7. Specify that it was a virtual treatment on invoices. 

• physiotherapy
• long-term-care
• retirement-home
• virus
• corona
• virtual-care
• covid

• physiotherapy
• long-term-care
• retirement-home
• ministry-of-health
• corona
• personal-protective-equipment
• ppe
• covid
• viurs

The current guidance regarding testing is that any Ontarian, including health care providers, who has at least one symptom of COVID-19 should get tested.

With the emergence of the Omicron variant and rising case numbers, the Ministry have released interim guidance for all health care providers who have been in contact with an individual who is COVID-19 positive. If you have been notified of a high-risk contact with a COVID case within any healthcare setting, you must self-isolate regardless of vaccination status and get tested as soon as possible. Contact your local public health unit for further information. 

If you work in certain settings like hospitals, long-term care homes and retirement homes, there are also specific circumstances where you may need to be tested. You should follow direction from your employer and/or local public health officials.

• health-care-provider
• covid-19
• testing

There is currently no general rule that requires PTs to disclose other work locations to their patients.

However, each PT should consider the following and decide on what information needs to be shared:

 •  Before each appointment, the PT must complete a point-of-care risk assessment, which may identify added risks with in-person care (i.e. patient vulnerability, immunocompromised patients, physical distancing, PPE use).

 •  Informed consent for physiotherapy care (whether in person or virtual) requires that the patient understands what will happen before the treatment begins, including the nature of the treatment, benefits, risks and alternatives, including virtual care.

Based on the risk assessment and professional judgement, the PT should decide what information (such as risks) should be shared to allow the patient to make an informed decision on their treatment at this time.  

Related Information:

In accordance with the Reopening Ontario (A Flexible Response to COVID-19) Act, employees of retirement and long term care homes must only work at one location unless they are fully vaccinated. These measures came into effect on April 22, 2020, and extend to employed health professionals of those facilities. Contractors of retirement and long term care homes should also limit the number of work locations to minimize risk to residents of exposure to COVID-19 (Directive #3 under the Long Term Care Homes Act).

• patient-care
• coronavirus
• ministry-of-health
• urgent-care
• screening
• covid
• screening-questions

If you work in private practice and your patient has screened positive for COVID-19, you must wear a fit-tested N95 mask, isolation gown, gloves, and eye protection (goggles or face shield). You must also provide the patient with a surgical mask. 

In addition, you must perform hand hygiene before and after contact with the patient and the patient environment, before you put on PPE, and after you remove it. Advise the patient to perform hand hygiene as well. 

If your patient has not screened positive for COVID-19 and you will be within two metres of the patient, you still need to wear a surgical or procedure mask. 

If the patient will be unmasked, you must wear eye protection. If the patient is masked, you might also consider wearing eye protection such as goggles or a face shield and an isolation gown, but they are not required. You must perform hand hygiene before and after contact with the patient.  
 
If the patient has been tested for COVID-19 and the results are pending, you should consider the patient positive and take all necessary precautions.  

Be sure to review the PPE recommendations in the Interim guidance document. 

• covid-19
• ppe

In general, everyday preventive actions can help prevent the spread of respiratory viruses, including: 

1. Wash your hands before and after providing treatment. Use soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer. 
2. Encourage patients to wash their hands when they arrive and before they leave —use signs to remind visitors to wash their hands, and have alcohol-based hand sanitizers and/or a handwashing station available.
3. Avoid touching your eyes, nose, and mouth with unwashed hands. 
4. Avoid close contact with people who are sick. 
5. Stay home when you are sick. 
6. Cover your cough or sneeze with a tissue, then throw the tissue in the trash, or use your sleeve. 
7. Clean and disinfect frequently touched objects and surfaces.** 
8. Ask patients to reschedule their appointment if they are feeling unwell.
9. If you have fever, cough and difficulty breathing, seek medical care early and share your recent travel history with your health care provider. 

In addition, workplaces should follow any routine infection prevention and control policies and procedures set out by their company or organization. Now is a good time to self assess your practices and make updates where necessary. 

Refer to the following Public Health Ontario documents for infection control guidance in clinical office practice:  

Infection Prevention and Control for Clinical Office Practice

IPAC Checklist for Clinical Office Practice

Consider posting additional signage to patients attending your clinic. Download this poster from the Ministry of Health and Long-Term Care that details what you need to know to keep you and your family healthy.  

Public Health Ontario Environmental Cleaning Fact Sheet

• physiotherapy
• patient-care
• private-practice
• clinic
• infection-prevention
• coronavirus
• covid-19

Consider the following:

1. Is it clinically appropriate based on each patient's needs or is an in-person visit required? 
2. Are there any physical, cognitive or sensory deficits that may make tele-practice unsafe or ineffective for a particular patient?  
3. Are you able to protect the safety of your patient’s personal health information? (consider your and the patient’s location as well as the technology itself - make sure it is PHIPA compliant) 
4. If the patient is located in another province you must be registered to practice in that jurisdiction 
5. Do you have a plan in place to deal with potential adverse events such as patient medical emergencies, failure of the communication technology or environmental hazards?  
6. Ensure you have the patient's consent - have a discussion with the patient and discuss things such as the difference between in-person and tele-rehabilitation services, options to receive in-person care, the risks to the privacy of their health information and any safeguards in place to reduce these risks.  
7. Specify that it was a virtual treatment on invoices 
   
   

The College has a resource page for virtual practice as well as a blog about tele-rehabilitation that will be useful. At the bottom of the blog there is a link to some FAQs and resources. In particular, the Canadian Alliance of Physiotherapy Regulators has publications related to tele-practice.

CPA Tele-Practice Checklist

• covid-19
• virtual-care

The College reminds PTs of the Ontario government directive to prioritize virtual care, and only see patients where the benefits of in-person care outweigh the risks of transmission. Consider holding group rehab classes virtually, to minimize the risk of viral transmission to your patients.

To minimize the spread of COVID-19, the Ontario Response Framework outlines that in those regions where in-person group classes are allowed under the restrictions, 3-meters of distance between participants should be observed. The public health measure level for each region can be found on the Ontario website.

The College is aware of additional restrictions imposed by certain local public health units, such as defining minimum square footage for each participant. Contact your local public health unit for further information on these or additional measures.  

Virtual practice is permitted by the College of Physiotherapists of Ontario for physiotherapy care if the care provided (like any other care) meets all the College standards, and is in the best interest of the patient. Virtual care is not new and was used by PTs before the pandemic.

Some physiotherapy may be delivered virtually in a group setting, but that does not exempt a physiotherapist from meeting all the College Standards and rules. You can see a list of those rules here.

You should:

• Discuss the privacy and confidentiality risks and the precautions taken with each patient.
• Get the patient's consent in the same way you would for an in-person assessment or treatment. In the case of virtual practice, you must be sure the patient understands explicitly how the assessment or treatment will work using technology.
• Document the discussion that you had with the patient in the patient's record.
• The Record Keeping Standard applies in the same way whether the care is delivered face-to-face, in a group, or virtually. The patient assessment, diagnosis, goals of the treatment and a treatment plan must be charted. You should make it clear in the patient's record and invoice if treatment was delivered virtually and in a group.
• The College of Physiotherapists of Ontario cannot recommend physiotherapy fees. All costs must be transparent to the patient and have been agreed to before the service is provided. The invoice or patient record should indicate group treatment and that the treatment was delivered virtually.
• The decision as to whether something is covered by insurance, whether virtual and/or group therapy classes, is the decision of each insurance carrier.

Key take away:

If physiotherapy is delivered virtually, in a group or even one-on-one, all College standards must be met by the physiotherapist in the same way.

Standards & Resources

Physiotherapists working in the Community Physiotherapy Clinic (CPC) program can now use virtual care as a temporary option to provide physiotherapy services as Episodes of Care, with some limitations:

• The clinic must have the capacity and digital tools available to provide virtual care.
• All virtual services must be delivered on a one-on-one basis.
• Assessments must be done using a video component. Telephone-only assessments are not permitted.
• Virtual care provided over the telephone is limited to patients receiving advice on self-management, education and coaching, or review of the patient’s home exercise plan.
• If the clinic will be providing publicly-funded physiotherapy services under the CPC program by virtual care, they must notify the Ministry by email at MOH.Physiotherapyagreements@ontario.ca.

The current guidance regarding testing is that any Ontarian, including health care providers, who has at least one symptom of COVID-19 should get tested.

With the emergence of the Omicron variant and rising case numbers, the Ministry have released interim guidance for all health care providers who have been in contact with an individual who is COVID-19 positive. If you have been notified of a high-risk contact with a COVID case within any healthcare setting, you must self-isolate regardless of vaccination status and get tested as soon as possible. Contact your local public health unit for further information. 

If you work in certain settings like hospitals, long-term care homes and retirement homes, there are also specific circumstances where you may need to be tested. You should follow direction from your employer and/or local public health officials.

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Patients can still contact your clinic. It would be advisable to set a date and time when you would contact the patient over the phone or through other electronic means to discuss the nature of their condition. If an in-person assessment is required, the patient could attend the practice as long as the following safeguards are in place:

• Patients should be screened for COVID-19 risk factors prior to booking the appointment and again upon arrival at the appointment. See above for Ministry Updates: Patient Screening Guidance Document.
• Personal protective equipment must be available and staff must be trained on its use.
• Social distancing must be practiced in the waiting and in the clinic.
• Follow the government’s recommended infection control measures, such as frequent cleaning and disinfecting of any equipment used and high touch areas and surfaces.
• The practice should have minimal employees present to ensure that this patient can be assessed, payment can be processed, and the treatment area can be thoroughly disinfected after the patient leaves.

Be sure to check the Ministry’s website regularly for the most up to date guidance for healthcare providers.

Infection Control and Equipment Maintenance Standard

The following recommendations are for in-person care for patients that have screened negative for COVID-19. 

For physiotherapists providing care in patient’s homes as per the direction from the Canadian government (Infection Prevention and Control for COVID-19: Interim Guidance for Home Care Settings) 

Important measures to prevent introduction and spread of COVID-19 in and between client homes:

• Staff must follow current infection prevention and control guidelines for use of personal protective equipment (PPE) while in the home.
• All staff must be trained in putting on a mask outside of each client's home and wearing a mask at all times for the duration of their visit in the home and discarding it afterward and in properly assessing the need for additional PPE, putting it on, wearing and removing it to minimize contamination of themselves and the immediate environment.
• Use of eye protection by staff (e.g., a face shield) for the duration of their visit in the client's home should be strongly considered.
• All staff must use Droplet and Contact Precautions, in addition to Routine Practices, for all client contact and care, when the client (or someone in their home) is suspected or confirmed to be infected with COVID-19.

For physiotherapists seeing urgent cases in clinics as per the guidance from the Ministry of Health: Health and Safety Guidance During COVID-19 For Physician and Primary Care Provider Employers

• Primary care providers who do not have a barrier and cannot maintain a 2-metre distance should use contact/droplet precautions until a negative screen is confirmed. For all other sectors, Ontario Health has issued Recommendations on the Use and Conservation of PPE. The use of PPE should be based on the assessment of risk. Specific PPE recommendations have been issued for interacting with suspected or confirmed COVID-19 patients, and for performing aerosol-generating medical procedures (AGMP).
• If an in-person visit is offered, patients should be advised to wear their own cloth mask to the office/clinic if they have one available to them. 

A fitness facility is not a typical health care setting. However, the interactions between a physiotherapist and their patients remain under the direction of the Ministry of Health. As a physiotherapist, read and apply the Ministry of Health: Guidance for the Health Sector.

It includes putting masks on yourself and your patients, good hand hygiene, eye protection if deemed appropriate, and cleaning and disinfection of patient contact surfaces.

The re-opening of gyms is following a regional approach. Some rules will be stricter than others. Some gym members are exempt from wearing a mask, while other gyms exercise their right to make masks mandatory.

It is vital to continue to follow social distancing rules. You may also consider modifying your schedule to avoid any patients who are at risk for complications from COVID-19 to attend at a busy time. Be sure to work with the gym manager to ensure that all public health measures (gym staff masking, member screening, disinfection protocols, social distancing) are followed to ensure the safest possible experience for your patients. 

Check your local public health unit for updates, or if you have COVID related questions, call the Ministry of Health's health care providers hotline at 1-866-212-2272.

There is currently no general rule that requires PTs to disclose other work locations to their patients.

However, each PT should consider the following and decide on what information needs to be shared:

• Before each appointment, the PT must complete a point-of-care risk assessment, which may identify added risks with in-person care (i.e. patient vulnerability, immunocompromised patients, physical distancing, PPE use).
• Informed consent for physiotherapy care (whether in person or virtual) requires that the patient understands what will happen before the treatment begins, including the nature of the treatment, benefits, risks and alternatives, including virtual care.

Based on the risk assessment and professional judgement, the PT should decide what information (such as risks) should be shared to allow the patient to make an informed decision on their treatment at this time.  

Related Information:

In accordance with the Reopening Ontario (A Flexible Response to COVID-19) Act, employees of retirement and long term care homes must only work at one location. These measures came into effect on April 22, 2020, and extend to employed health professionals of those facilities. Contractors of retirement and long term care homes should also limit the number of work locations to minimize risk to residents of exposure to COVID-19 (Directive #3 under the Long Term Care Homes Act).

Based on the Ministry of Health: Guidance for the Health Sector, PTs in this scenario are encouraged to contact their local public health unit for advice on potential exposure and continuation of work.

To note, with rising case numbers and the emergence of the Omicron variant, the Ministry released interim guidance in December 2021 for all health care providers who have been in contact with an individual who is COVID-19 positive. If you have been notified of a high risk contact with a COVID case within any healthcare setting, you must self-isolate regardless of vaccination status and get tested as soon as possible. Contact your local public health unit for further information.

PTs should only use products with a Drug Identification Number (see below), which confirms approval by Health Canada. Make sure to also check the expiry date and follow the product’s instructions for use.

Public Health Ontario provides further helpful guidance on cleaning and disinfecting during COVID, with specific best practices on cleaning for the prevention and control of infections in health care settings.

In a health emergency such as a pandemic, physiotherapists are valuable members of the health care team who may be asked to participate in activities that are outside their normal duties.

PTs may be asked to assist with mask fit testing or screening procedures. Some of the activities that physiotherapists may be asked to perform are considered controlled acts and require delegation by a practitioner who is authorized to perform them.

Recognizing these activities may not be common practice for PTs, they could only be done with adequate training on the procedures and if given the required personal protective equipment.

With appropriate safeguards in place we would expect physiotherapists to be flexible during situations of health emergencies to assist the health care system manage increased demands.  We do acknowledge that there may be individual exceptions to this and we encourage those PTs therapists to have discussions with their organizations to address these concerns.

The government of Ontario has implemented additional measures to ensure health care resources are available to help prevent the spread of COVID-19. Read more about those emergency measures. 

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It is a physiotherapist’s responsibility to provide safe and competent care in whatever setting they find themselves working in. All PTs have demonstrated a basic competency in cardiorespiratory physical therapy as a result of successfully completing the Physiotherapy Competency Exam (PCE). 

PTs must refresh their skills by reviewing the theoretical and practical elements of working in such an environment. Wherever possible, it is recommended that they successfully complete training, which includes an evaluation or self-assessment of knowledge and skills. The College does not endorse specifics courses, but PTs can find reputable course in a number of places, including the CPA, OPA, by speaking with their peers or doing online research.     

Also, if a PT is going to administer oxygen or perform tracheal suctioning for example, they must roster before performing these higher risk activities.

Important: If a physiotherapist changes jobs or employers, they are required to update that information on the College’s Public Register within 30 days.

Update your employment information

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A PT is accountable to provide safe and effective care to each patient. If you are not competent, the College recommends you look for ways to update your knowledge and skills in the practice area in which you are being asked to provide care.

During the COVID-19 outbreak, PTs may be asked to perform tasks usually considered to be outside their scope of practice or in a practice unfamiliar to them.

The College encourages PTs to get additional training to ensure their competency. PTs are accountable for advocating for practice settings that minimize risk to both the PT and the patient.

Physiotherapists should work with their employers to get the training they need to allow them to deliver the best possible care during this challenging time. If after having taken these steps the PT does not feel competent, they can refuse to provide care if they believe it puts themselves or the patient at risk.

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If a PT is deployed to different practice setting and remains working in the role of a physiotherapist, then they must continue to keep patient records and meet the expectations outlined in the Record Keeping Standard.

However, if the PT is deployed to different, non-physiotherapist role (taking naso-pharyngeal swabs from patients or assisting in ICU to sterilize equipment for example), they should follow their employer’s guidance rather than the College’s as to what needs to be recorded.

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Yes, these are unprecedented times and the Government of Ontario is committed to ensuring that there are sufficient resources available in publicly funded settings to assist with the care of COVID-19 patients. In a health emergency such as the current pandemic, physiotherapists are valuable members of the health care team who may be asked to participate in activities that are outside their normal duties.

Some of the activities that physiotherapists may be asked to perform are considered controlled acts and require delegation by a practitioner who is authorized to perform them. Recognizing these activities may not be common practice for PTs, they should only be done with adequate training on the procedures and if given the required personal protective equipment.

Further direction about what you can and can’t be asked to do will be available from your employer or the various directions issued by the government. The College is unable to provide physiotherapists with a list as to what they should and should not be doing when deployed to a different position. With appropriate safeguards in place we would expect physiotherapists to be flexible during situations of health emergencies to assist the health care system manage increased demands.

There are a number of free resources and training courses available to physiotherapists during this time. View a list of online training and resources. 

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On March 12, 2020, Public Health Ontario issued some guidance regarding when PPE should be used by health care providers who provide direct care to patients with suspected or confirmed COVID-19. 

This document was updated on March 25, 2020 and additional direction was provided by the Chief Medical Officer of Health on March 30, 2020. 

The updated direction from March 30 requires the following:

• A point-of-care risk assessment (PCRA) must be performed by every health care worker before every patient interaction. 
  
  
• At a minimum, contact and droplet precautions must be used by workers for all interactions with suspected, presumed or confirmed COVID-19 patients. Contact and droplet precautions includes gloves, face shields or goggles, gowns, and surgical/procedure masks. 
  
  
• All workers who are within two metres of suspected, presumed or confirmed COVID-19 patients shall have access to appropriate PPE. 

• This will include access to surgical/procedure masks, fit tested NIOSH-approved N-95 respirators or approved equivalent or better protection, gloves, face shields with side protection (or goggles), impermeable or, at least, fluid resistant gowns.
  
  
• Airborne precautions which include a N95 respirator or approved equivalent or better are to be used when aerosol generating medical procedures (AGMPs) are planned or anticipated to be performed on patients with suspected or confirmed COVID- 19, based on a point of care risk assessment and clinical and professional judgement. 

The use of PPE is one of many measures recommended to prevent transmission. The use of PPE (and which specific PPE to use) is based on the risk of transmission for the type of activity. If the situation suggests the use of PPE, you are supposed to use it.

Healthcare providers should refer to Public Health Ontario’s latest guidance on IPAC and use of PPE, as the guidance is evolving based on latest evidence.

We understand that there is a shortage of masks, N95 respirators and other PPE. We understand that there are efforts being made to secure these resources but that it may take some time to distribute them to all the organizations and facilities that need them. 

Whether you choose to continue to provide care without PPE is up to you. If you are inclined to refuse to provide care you may wish to consult with your employer, union and/or legal counsel for employment and/or liability concerns to seek their guidance. In addition, many liability insurance policies include a free consultation line and you may wish to access this. The College cannot advise you to stop treating patients.

The Public Health Agency of Canada has asked Canadians not to dispose of their used PPE but to save it for potential reuse. While the Ministry is waiting on the evidence and guidance for reuse, Ontario Health is asking hospitals to store used PPE securely and is distributing a survey to understand hospital capacity for reprocessing, based on promising technologies to safely reuse PPE. This is being done pre-emptively to ensure readiness for all possible scenarios.

In situations where supply is limited, extended use (continued use between patients without doffing when providing care to patients infected with the same pathogen) and reuse of PPE may be considered.

Remember, you must follow adequate disinfection processes. Contamination of respirator surfaces is common, and doffing or re-donning of the same respirator without adequate disinfection may result in infection transmission. Expired stockpiles of single-use PPE (e.g. masks, N95 respirators), if available and intact, may also be used.

PPE designed for reuse (e.g. elastomeric respirators) is another alternative. Cleaning and disinfection of the product must follow the manufacturer’s instructions for use. 

For more information, please consult the research produced by Public Health Ontario.

If a formal complaint comes to the College’s attention, we are required to look into it. If a physiotherapist is unable to provide adequate physiotherapy services because there are insufficient resources available, the PT can discontinue care. 

If possible, you should speak to an Occupational Health and Safety Manager or someone who has a similar role at your organization to try and resolve the equipment issue. 

For the protection of the patient and the physiotherapist, the PT should consider alternative options to meet the patient’s care needs and make alternative arrangements where possible. It is important that physiotherapist’s document their decision-making process in the patient chart.

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Yes. The following information is from Directive #5 for Hospitals and Long-Term Care Homes: 

 •  A point-of-care risk assessment (PCRA) must be performed by every regulated health professional before every patient or resident interaction in a public hospital or long-term care home. 

 • At a minimum, for regulated health professionals and other health care workers in a hospital or a long-term care home, Droplet and Contact Precautions must be used by regulated health professionals and other health care workers for all interactions with suspected, probable or confirmed COVID-19 patients or residents. Droplet and Contact Precautions include gloves, face shields or goggles, gowns, and a well-fitted surgical/procedure masks. 

 • Additionally, as an interim precaution in light of the uncertainty around the mechanisms of transmission of the COVID-19 Omicron variant of concern (B.1.1.529), required precautions for all health care workers providing direct care to or interacting with a suspected, probable (i.e. placed in precautions as high risk contact, in an outbreak zone of the facility or recently transferred from a facility in outbreak) or confirmed cases of COVID-19 are a fit-tested, seal-checked N95 respirator (or approved equivalent), eye protection (goggles or face shield), gown and gloves.  

 • All regulated health professionals and health care workers providing direct care to or interacting with suspected, probable or confirmed COVID-19 patients or residents shall have access to appropriate PPE. This will include access to: surgical/procedure masks, fit tested, seal-checked N95 respirators (or approved equivalent), gloves, face shields with side protection (or goggles) and appropriate isolation gowns. 

 • The public hospital or long-term care home will not deny access to a fit-tested, seal-checked N95 respirator (or approved equivalent). 

 • Fit-tested, seal-checked N95 respirators (or approved equivalent), must be used by all regulated health professionals and health care workers in the room where Aerosol Generating Medical Procedures (AGMPs) are being performed, are frequent or probable. 

 • AGMPs include but are not limited to; Intubation and related procedures (e.g. manual ventilation, open endotracheal suctioning), cardio pulmonary resuscitation, bronchoscopy, sputum induction, non-invasive ventilation (i.e. BiPAP), open respiratory/airway suctioning, high frequency oscillatory ventilation, tracheostomy care, nebulized therapy/aerosolized medication administration, high flow heated oxygen therapy devices (e.g. ARVO, optiflow) and post-mortem care. Any change to this list is to be based on the Technical Brief "Updated IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19" dated December 15, 2021 as amended from time to time which has been prepared by Public Health Ontario. 

In accordance with O. Reg 68/20 made under the Retirement Homes Act, retirement homes must take all reasonable steps to follow the required precautions and procedures outlined in this Directive.  

Note: As this outbreak evolves, there will be continual review of emerging evidence to understand the most appropriate measures to take. This will continue to be done in collaboration with health system partners and technical experts from Public Health Ontario and within the health system.  

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In a health emergency such as the current pandemic, physiotherapists and PTAs are valuable members of the health care team who may be asked to participate in activities that are outside their normal duties, such as filling much needed roles at the Long-Term Care facilities that have been seriously affected by COVID-19.

PTs/PTAs may be asked to assist with activities normally performed by a PSW. Some of the activities that physiotherapists may be asked to perform are considered controlled acts and require delegation by a practitioner who is authorized to perform them.

Recognizing these activities may not be common practice for PTs, they could only be done with adequate training on the procedures and if given the required personal protective equipment.

With appropriate safeguards in place we would expect physiotherapists to be flexible during situations of health emergencies to assist the health care system manage increased demands. We do acknowledge that there may be individual exceptions to this and we encourage those PTs therapists to have discussions with their organizations to address these concerns.

Questions of liability when away from the hospital setting should be addressed with your employer as well as your personal liability insurer.

The government of Ontario has implemented additional measures to ensure health care resources are available to help prevent the spread of COVID-19. Read more about those emergency measures. 

The current guidance regarding testing is that any Ontarian, including health care providers, who has at least one symptom of COVID-19 should get tested.

With the emergence of the Omicron variant and rising case numbers, the Ministry have released interim guidance for all health care providers who have been in contact with an individual who is COVID-19 positive. If you have been notified of a high-risk contact with a COVID case within any healthcare setting, you must self-isolate regardless of vaccination status and get tested as soon as possible. Contact your local public health unit for further information. 

If you work in certain settings like hospitals, long-term care homes and retirement homes, there are also specific circumstances where you may need to be tested. You should follow direction from your employer and/or local public health officials.

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• covid-19
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There is currently no general rule that requires PTs to disclose other work locations to their patients.

However, each PT should consider the following and decide on what information needs to be shared:

• Before each appointment, the PT must complete a point-of-care risk assessment, which may identify added risks with in-person care (i.e. patient vulnerability, immunocompromised patients, physical distancing, PPE use).
• Informed consent for physiotherapy care (whether in person or virtual) requires that the patient understands what will happen before the treatment begins, including the nature of the treatment, benefits, risks and alternatives, including virtual care.

Based on the risk assessment and professional judgement, the PT should decide what information (such as risks) should be shared to allow the patient to make an informed decision on their treatment at this time.  

Related Information:

In accordance with the Reopening Ontario (A Flexible Response to COVID-19) Act, employees of retirement and long term care homes must only work at one location. These measures came into effect on April 22, 2020, and extend to employed health professionals of those facilities. Contractors of retirement and long term care homes should also limit the number of work locations to minimize risk to residents of exposure to COVID-19 (Directive #3 under the Long Term Care Homes Act).

As a physiotherapist, using social media to interact with patients, potential patients and your colleagues can be exciting, but if you’re not careful, can come with some risk. Although the College does not have an official social media policy, there are resources available to help. Check out the Physiotherapy Alberta College + Association article on social media. It is full of best practices and tips, and is a great place to start.  

The Alberta College of Physiotherapists

Your relationship with patients should stay on a professional level and this includes online connections. It is okay to "friend" or use social media platforms to connect with patients for professional purposes. For example, sharing general advice, prevention tips, and exercises, or to promote your physiotherapy practice is acceptable. But you would not want to "friend" someone to pursue a personal relationship, so you should refrain from adding them to your personal accounts.

Consider having a professional social media account that is separate from your personal account. 

Check these out: 

• College Blog Post on Social Media
• Physiotherapy Alberta - College & Association Resource

You should not accept "friend" requests from patients or follow them on personal social media sites. It is not appropriate and crosses the boundary of being a person’s health provider. It is important to think about how you will reject these kinds of requests before they take place. Consider developing a policy in your workplace to address these kinds of requests so you can refer the patient to it should they ask. It might also be helpful to develop a script of how to nicely say no and explain why to the person.  

Posting general health information that could apply to a wide range of people is okay. However, it cannot be patient specific. Clinical advice meant for a specific patient should only be provided as part of a physiotherapy appointment, after an assessment of the patient has been completed — it should not be done through social media.

Get in touch with your liability insurance provider before posting advice on social media to verify you are covered in this circumstance.

Tele-rehabilitation or digital health is permitted when clinically appropriate as long as you meet professional standards, especially the privacy expectations.

Here is to more information about tele-rehab or digital health.  

Before you post any general physiotherapy advice, physiotherapists should confirm with their liability insurance provider to verify whether or not they are covered for this activity.

Learn more about liability insurance requirements.

Yes. You can use social media to reach out and engage with patients and prospective patients. It is strongly recommended that physiotherapists create separate social media profiles that can be used only for business purposes (completely separate from any personal profiles). It is fine to have personal social media accounts, but you must be mindful of the fact that patients may see those as well.

Everything on your professional social media accounts must respect privacy laws, maintain professional boundaries, and meet the expectations outlined in the Advertising Standard.

If patients will be contacted by social media, they must give consent. The same way you would ask patients if it is ok to contact them via phone or text. Your communication with patients should relate strictly to their physiotherapy care.

Even though there is no rule preventing you from looking up your patients on their personal social media sites online, it is likely not in the best interest of the patient. Be aware that depending upon the social media site they may be able to see that you were visiting their personal profile. Consider whether that might make them feel uncomfortable.

If a patient has not shared details of their personal life during their appointment, they likely do not want to you looking at their online life. Doing this could breach professional boundaries, jeopardizing patient trust and threaten the therapeutic relationship you have with your patient.

Remember that anything you post should be assumed to be for everyone and forever.

Remember that even the strictest of privacy settings do not always prevent others from viewing or sharing your posts for unintended audiences to see. As trusted health care professionals, physiotherapists should not post information that may be viewed as unprofessional as it can impact patient trust and threaten the professions reputation.

As a general rule of thumb, if you wouldn’t be comfortable sharing the content with everyone, why post it?

It depends on whether or not the patient you see screens positive for COVID-19.

The rules around the use of gowns and other PPE are summarized in the Ministry of Health's Guidance for the Health Sector. 

You must wear a gown and full PPE if you are treating a patient who has screened positive for COVID-19.

For all interactions with and within 2 metres of patients who screen positive, you must use droplet and contact precautions:

• Surgical/procedure mask
• Isolation gown
• Gloves
• Eye protection (goggles or face shield)
• Perform hand hygiene before and after contact with the patient and the patient environment and after the removal of PPE

Gowns are not specifically required when treating patients who screen negative for COVID-19.

• Use a surgical/procedure mask
• Consider the use of eye protection (goggles or face shield)
• Perform hand hygiene before and after contact with the patient and the patient environment and after the removal of PPE

For all interactions with and within two metres of patients who screen negative, you must:

Gowns must be worn if contamination of your uniform or clothing is anticipated: see page 37 of Ontario’s Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings.

You can use cloth privacy screens and curtains in your practice, however you should be aware that the use of cloth privacy screens and curtains increases the risk of microbial contamination.

If you use/continue to use cloth privacy screens or curtains, consider applying the guidance applicable to the use of curtains in other health care environments to your circumstances, where it is applicable, to promote a safe environment for patients and colleagues: see pages 22 - 23 in Ontario’s Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings.

The idea is not to have all clinics quickly return to a pre-COVID state, but rather a slow, controlled restart where COVID-19 precautions are in place protecting patients, staff, you and the broader public. You should only resume practice if it is safe to do so and all additional precautions are in place. 

The precautions are clearly explained in the Ministry of Health's Guidance for the Health Sector. 

Encourage PT employers to read the materials provided by government and the College. There is a section on the College website specifically for employers – COVID-19: Return to Work Information for Employers.

Employers are also encouraged to contact the College’s advice team with any specific questions they might have at advice@collegept.org or call 1-800-583-5885 ext. 241.

There is currently no general rule that requires PTs to disclose other work locations to their patients.

However, each PT should consider the following and decide on what information needs to be shared:

• Before each appointment, the PT must complete a point-of-care risk assessment, which may identify added risks with in-person care (i.e. patient vulnerability, immunocompromised patients, physical distancing, PPE use).
• Informed consent for physiotherapy care (whether in person or virtual) requires that the patient understands what will happen before the treatment begins, including the nature of the treatment, benefits, risks and alternatives, including virtual care.

Based on the risk assessment and professional judgement, the PT should decide what information (such as risks) should be shared to allow the patient to make an informed decision on their treatment at this time.  

Related Information:

In accordance with the Reopening Ontario (A Flexible Response to COVID-19) Act, employees of retirement and long term care homes must only work at one location. These measures came into effect on April 22, 2020, and extend to employed health professionals of those facilities. Contractors of retirement and long term care homes should also limit the number of work locations to minimize risk to residents of exposure to COVID-19 (Directive #3 under the Long Term Care Homes Act).

You should discuss risks with the patient. This includes things like potential exposure to COVID-19 while attending the clinic, the potential that you (the PT) may have to be less than two metres away from the patient and that the care might involve touching.

You should explain that there may be others in the clinic area at the time of their appointment, including staff and other patients. Be sure to outline the extra infection control and precautions that you have in place. You should help the patient to determine if they fall into a high-risk category for complications of COVID-19 if acquired. 

The patient has the right to understand and consider the risks and potential benefits before attending an in-person appointment. You should also make it clear that virtual practice is still an option if that is an option in your workplace.

Remember that you must screen all patients for COVID-19 before booking an appointment. 

 •  Your patient’s needs and how they have changed or will change over time

 •  Any negative patient outcomes that could arise from further delays

 •  The benefit and/or patient perceived benefit of providing physiotherapy

 •  Consider if there is an outbreak in your community, and the risk of exposure/transmission to the patient or caregiver/family member who will attend the appointment

 •  Will a patient come by public transport and what extra risk or burden is placed on the patient versus the benefit from the care provided?

 •  Do you have enough PPE to protect you, your staff and the patient?

 •  Does your practice meet the other expectations for COVID-19 precautions (for example the operational requirements set out by the Ministry of Health)?

If you work in private practice and your patient has screened positive for COVID-19, you must wear a fit-tested N95 mask, isolation gown, gloves, and eye protection (goggles or face shield). You must also provide the patient with a surgical mask. 

In addition, you must perform hand hygiene before and after contact with the patient and the patient environment, before you put on PPE, and after you remove it. Advise the patient to perform hand hygiene as well. 

If your patient has not screened positive for COVID-19 and you will be within two metres of the patient, you still need to wear a surgical or procedure mask. 

If the patient will be unmasked, you must wear eye protection. If the patient is masked, you might also consider wearing eye protection such as goggles or a face shield and an isolation gown, but they are not required. You must perform hand hygiene before and after contact with the patient.  
 
If the patient has been tested for COVID-19 and the results are pending, you should consider the patient positive and take all necessary precautions.  

Be sure to review the PPE recommendations in the Interim guidance document. 

Based on the Ministry of Health: Guidance for the Health Sector, PTs in this scenario are encouraged to contact their local public health unit for advice on potential exposure and continuation of work.

To note, with rising case numbers and the emergence of the Omicron variant, the Ministry released interim guidance in December 2021 for all health care providers who have been in contact with an individual who is COVID-19 positive. If you have been notified of a high risk contact with a COVID case within any healthcare setting, you must self-isolate regardless of vaccination status and get tested as soon as possible. Contact your local public health unit for further information.

This is not a straightforward question. PTs must follow the guidelines for physical distancing in their workplace. This includes keeping a minimum two metre distance between patients, as well as staff. This may be difficult or impossible to do in a smaller area.

PTs must also disinfect all patient contact surfaces and areas within two metres of patients before having another patient in the area.

Ministry of Health: Guidance for the Health Sector

The screening tool is designed to be interpreted and adapted using the health professional's judgement and local context. Refer to page 4 of the COVID-19 Guidance: Primary Care Providers in a Community Setting for more information. 

There are regional considerations when someone has crossed a provincial border (for example, Ottawa/Gatineau is considered as the National Capital Region) and there are employee considerations (an ICU nurse who only sees COVID-19 patients with full PPE).

If you have the proper PPE to see someone who screens positive, you can still see these patients.

Consider scheduling extra time around their appointment to allow for disinfection of all surfaces and seeing them at a time of day which would minimize their interactions with others. 

You are not obligated to see someone who is a positive screen for COVID-19 if you do not feel you are adequately prepared to do so. 

Carpets are not recommended in health care facilities and should not be used within the treatment areas. For facilities that have not yet removed all carpeting from care areas, there should be a plan for the permanent removal of carpeting. 

In the interim, carpets should be vacuumed, and all spills and dirt removed immediately and a shampoo cleaning should be scheduled. 

Please refer to the Public Health Ontario document below for more information on cleaning surfaces. 

Ontario’s Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings. (See pages 23 and 98-99)