Ethics & Law in Practice for the Indiana Physical Therapy Practitioner

Learning Outcomes-Ethics Segment

After completing this course, participants will be able to:

• Differentiate between core healthcare ethical principles and their specific application within PT contexts.

• Analyze the nine Ethical Commitments of the unified APTA Code of Ethics

• Identify at least three common ethical issues experienced in healthcare settings.

• Analyze ethically complex scenarios in physical therapy practice using the RIPS model

Section 1: What Is Ethics?

Defining Ethics and Morality

Ethics is the branch of philosophy concerned with questions of right and wrong, good and bad, and how we ought to act toward one another. At its core, ethics involves systematic reflection on moral beliefs — examining not just what we do, but why we do it and whether our actions can be justified.

The term morality is closely related and often used interchangeably with ethics in everyday conversation, but a useful distinction exists. Morality generally refers to the values, norms, and beliefs that individuals and communities hold about right conduct — the lived experience of distinguishing right from wrong. Ethics, by contrast, is the disciplined study and analysis of those moral beliefs. In professional contexts, ethics asks us to move beyond intuition and custom to reason carefully about what we owe to the people we serve.

This distinction matters for healthcare professionals because acting morally is not simply a matter of following instinct or doing what feels right. As a licensed PT or PTA, you bring both a personal moral framework and a professional ethical identity to every clinical encounter. Understanding how those two layers interact and sometimes conflict is fundamental to ethical practice.

Ethics, Law, and Professional Standards: Related but Not the Same

One of the most important early lessons in professional ethics is recognizing that ethics, law, and professional standards are related but distinct systems of obligation. Many practitioners assume that behaving legally is equivalent to behaving ethically, or that following a professional standard automatically satisfies the demands of good moral practice. Neither assumption holds.

Law represents the codified rules of society, enforceable by governmental authority. Laws set minimum thresholds for acceptable behavior and carry formal consequences such as fines, license revocation, criminal prosecution, when violated.

Professional standards go beyond what the law requires and reflect the values a profession has collectively committed to upholding. In physical therapy, that standard is now articulated in the Code of Ethics for the Physical Therapy Profession, adopted by the APTA House of Delegates in 2025 and effective January 1, 2026.

Ethics operates at a still deeper level than either law or professional standards. An action can be entirely legal, fully compliant with professional standards, and yet remain ethically troubling. Consider a PT who provides technically adequate care but never takes time to ensure a patient with limited health literacy truly understands their diagnosis or home program. Nothing violates the law, yet the practitioner has failed to honor the patient's autonomy and right to informed participation in their own care.

Understanding where law ends, where professional standards begin, and where ethical responsibility extends beyond both is essential preparation for the complexity of clinical life.

Why Ethics Matters in Physical Therapy

Healthcare is defined by vulnerability, trust, and power imbalance. Patients come to physical therapists during some of the most difficult periods of their lives, such as recovering from injury or surgery, managing chronic pain, adapting to disability, or striving to regain independence. This vulnerability creates a profound ethical responsibility. Patients must trust that their providers will prioritize their well-being, respect their dignity, tell them the truth, and protect their private information. That trust is not incidental to physical therapy practice; it is the very foundation of the therapeutic relationship.

Ethics matters not only because individual patients deserve protection but because the integrity of the healthcare system depends on practitioners who are reflective, accountable, and committed to something larger than technical competence. A physically skilled practitioner who lacks ethical grounding can cause real harm through dishonesty, disregard for patient preferences, exploitation of vulnerable individuals, or failure to advocate for equitable care. Conversely, practitioners who engage thoughtfully with ethical questions contribute to a culture of accountability that benefits patients, colleagues, and the profession as a whole.

The ethical dimensions of physical therapy are not confined to the one-on-one clinical relationship. Ethical obligations operate simultaneously at the individual, organizational, and societal levels — shaping how you communicate with a patient, respond to institutional pressure, and advocate for vulnerable populations and health equity.

Research confirms that ethical challenges are not rare events in physical therapy; they are a routine feature of clinical work. What is equally clear from the research is that many practitioners feel underprepared to navigate them. This gap between the frequency of ethical challenges and the readiness to address them is precisely why formal ethics education matters. Ethical competence, like clinical competence, must be developed deliberately, practiced consistently, and refined through experience and reflection.

Section 2: Foundational Ethical Principles

Six principles form the ethical foundation of physical therapy practice: autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity. Each is examined below with attention to both theoretical demands and practical application.

Autonomy

Autonomy recognizes every patient's right to make informed decisions about their own care. Derived from Greek words for "self" and "law," autonomy reflects the moral conviction that individuals are the legitimate authors of their own lives and that healthcare providers have an obligation to support, not override, that authorship.

In physical therapy practice, respecting autonomy means far more than obtaining a signature on a consent form at the outset of care. It encompasses a commitment to ongoing informed consent throughout treatment, ensuring patients have the information they need to make meaningful choices at every stage.

Autonomy also encompasses privacy and confidentiality. Patients share sensitive information because the therapeutic relationship requires it, not because they have forfeited their right to control that information. Violations of these obligations, even inadvertent ones, represent a failure to honor the person behind the patient role.

In practice, autonomy can be difficult to uphold. Patients may make decisions their therapist believes are not in their best interest, such as refusing a recommended intervention, declining a home exercise program, or choosing to discontinue care prematurely. Respecting autonomy means accepting that a competent patient's right to decide for themselves takes precedence over the clinician's judgment about what is best, even when that is difficult. The therapist's role in such moments is not to override the patient's choice but to ensure it is genuinely informed — that it reflects the patient's own values and a real understanding of available options and their likely consequences.

Beneficence

Beneficence is the obligation to act in the best interest of the patient and to actively promote good for the individual, the profession, and society. It is, in many ways, the animating principle of healthcare. In physical therapy, beneficence manifests in the commitment to providing care that is evidence-based, individualized, and genuinely oriented toward the patient's well-being rather than toward institutional convenience, financial incentive, or professional habit.

Beneficence extends beyond the individual clinical encounter. It calls on physical therapy professionals to advance the health and well-being of communities, contribute to the profession's development through education and scholarship, and advocate for healthcare systems that serve all people equitably.

Nonmaleficence

Nonmaleficence, the obligation to "do no harm," is perhaps the most widely recognized principle in healthcare ethics, yet it is also among the most frequently misunderstood. It is sometimes interpreted as a simple prohibition against causing injury, but nearly every therapeutic intervention carries some degree of risk. The principle does not require that clinicians eliminate all risk; it requires that they make deliberate, informed decisions that prevent or minimize harm and never expose patients to risks disproportionate to the potential benefits of treatment.

Nonmaleficence also applies to less visible harms such as emotional harm, harm to a patient's dignity, harm resulting from inadequate care, and harm caused by failing to refer when a situation exceeds one's scope of practice. Recognizing the limits of one's competence and acting accordingly is one of the most concrete expressions of the commitment to do no harm.

Justice

Justice refers to the fair and equitable distribution of care and resources, grounded in recognition of the mutual dignity of all human beings. At its most fundamental level, justice demands that patients receive care based on their clinical needs, not on the basis of race, ethnicity, gender, age, socioeconomic status, disability, sexual orientation, or any other characteristic unrelated to their healthcare needs.

Justice operates at multiple levels. At the individual level, it shapes how a clinician allocates attention across their caseload. At the organizational level, it informs resource allocation and the design of the care delivery system. At the societal level, justice calls on physical therapy professionals to advocate for policies that expand access to care and reduce health disparities.

Veracity

Veracity is the commitment to truthfulness and honest communication with patients, colleagues, payers, institutions, and the public. In clinical practice, veracity requires that physical therapy professionals provide patients with accurate information about their diagnoses, prognoses, and treatment options, even when the truth is difficult to deliver. It demands honest documentation and transparency about the limits of one's knowledge, including the willingness to say "I don't know" when that is the honest answer.

The obligation of veracity is not always comfortable. There are clinical situations in which the truth is unwelcome, and institutional pressures that can create incentives for less-than-fully-honest documentation. Veracity demands that practitioners resist these pressures. Trust in the therapeutic relationship and in the profession as a whole depends on it.

Fidelity

Fidelity is the principle of faithfulness — to promises, professional obligations, and the therapeutic relationship itself. It calls on physical therapy professionals to follow through on their commitments, treat every patient with consistent respect and integrity, and honor the trust patients place in them when they enter into the therapeutic relationship. Fidelity is expressed in the reliability with which a clinician shows up for their patients, not only in scheduling and continuity of care, but in the quality of attention, respect, and professional engagement they bring to every encounter.

Principles in Tension

These six principles do not always point in the same direction when applied to real clinical situations. A patient's autonomous choice may conflict with the therapist's beneficent desire to act in their best interest. Veracity may require delivering information that, in the short term, causes distress. These tensions are not failures of the ethical framework; they are the very substance of ethical practice. Learning to recognize when principles are in tension, reason carefully about competing obligations, and make defensible decisions under conditions of moral uncertainty is the central challenge of clinical ethics.

Section 3: Ethical Theories

Why Theory Matters in Practice

It is tempting to view ethical theory as remote from clinical reality and of limited practical use. This view is mistaken. Every time a clinician reasons through an ethical challenge, they are drawing, whether consciously or not, on theoretical frameworks that shape how they define the problem, what they count as relevant, and what kind of answer they find satisfying. Making those frameworks explicit does not make clinical ethics more complicated; it makes the reasoning more transparent, more rigorous, and ultimately more defensible.

This section introduces four major frameworks: deontological ethics, consequentialism, virtue ethics, and principlism. No single framework provides a complete account of moral life, and none should be applied mechanically. Rather, these theories function as lenses, each illuminating certain features of an ethical situation while potentially obscuring others.

Deontological Ethics: The Ethics of Duty

Deontological ethics holds that the moral quality of an action is determined not by its consequences but by whether it conforms to a rule, duty, or obligation. The most influential deontological theorist is Immanuel Kant, who argued that moral obligations are categorical; they apply universally and unconditionally, regardless of circumstances or outcomes.

In healthcare, deontological thinking underpins many of the obligations that practitioners feel most strongly about. The duty to obtain informed consent, the obligation to maintain patient confidentiality, the commitment to tell the truth even when it is uncomfortable — these are experienced less as calculations about outcomes and more as duties that hold regardless of the consequences. A deontological framework captures something important about why it feels wrong to lie to a patient, even if the lie might produce a better short-term outcome.

The primary limitation of deontological ethics is its rigidity. A strict duty-based framework can struggle to accommodate situations where rules conflict — where the duty to respect autonomy pulls against the duty to prevent harm. Deontological ethics is most useful when it reminds practitioners that some obligations are not negotiable and that the ends do not always justify the means.

Consequentialism: The Ethics of Outcomes

Consequentialist theories evaluate the moral quality of an action entirely by reference to its outcomes. The most influential form is utilitarianism — developed by Jeremy Bentham and John Stuart Mill — which holds that the morally correct action is the one that produces the greatest good for the greatest number. In healthcare contexts, utilitarian reasoning often surfaces in discussions of resource allocation, public health policy, and triage.

Consequentialist thinking offers a valuable counterweight to purely rule-based reasoning. It demands that clinicians pay attention to real-world outcomes and encourages thinking beyond the individual patient to the broader impact of decisions on families, communities, and healthcare systems.

The limitations of consequentialism become apparent when its logic leads to uncomfortable conclusions — for example, that poor-prognosis patients should receive fewer resources to maximize outcomes across a population. Such conclusions fail to honor the inherent dignity of the individual patient. Consequentialism is most useful as a lens that keeps practitioners attentive to the real-world effects of their decisions.

Virtue Ethics: The Ethics of Character

Virtue ethics shifts the central question from "What should I do?" to "What kind of person should I be?" Rooted in Aristotle's philosophical tradition, virtue ethics holds that ethical behavior flows from good character. Virtues such as honesty, courage, compassion, practical wisdom, and integrity are stable character traits that dispose a person to perceive situations clearly, feel appropriate emotions, and act well consistently over time.

Virtue ethics resonates deeply with healthcare culture. Being the kind of physical therapy practitioner patients can trust is not primarily about knowing the rules or calculating the best outcomes. It is about being honest, being compassionate, being courageous enough to deliver difficult news, and exercising the practical wisdom (what Aristotle called phronesis) to discern the right course of action in genuinely complex situations. The APTA's core values, including accountability, altruism, compassion, integrity, and excellence, reflect a distinctly virtue-oriented understanding of what it means to be a good practitioner.

Virtue ethics is most powerful when it reminds practitioners that ethics is not merely a matter of compliance but of becoming the kind of person whose patients, colleagues, and communities can rely upon.

Principlism: An Integrated Framework

Principlism is an integrated, middle-ground approach to healthcare ethics developed by philosophers Tom Beauchamp and James Childress in their landmark work, Principles of Biomedical Ethics — now in its eighth edition and widely regarded as the most influential text in the field. Principlism proposes that ethical reasoning in healthcare should be guided by four core principles: autonomy, beneficence, nonmaleficence, and justice, to which physical therapy adds veracity and fidelity.

The appeal of principlism lies in its practicality. Rather than committing to a single theoretical framework and applying it rigidly, principlism draws on the insights of multiple traditions — deontological, consequentialist, and virtue-based — while providing a common language that healthcare professionals from different backgrounds can share. The principles are presented not as an absolute hierarchy but as prima facie obligations: each is binding unless it conflicts with another principle of equal or greater weight in a specific situation. When principles conflict, the task is to reason carefully about which obligation takes precedence given the particular circumstances, values, and stakes involved.

Principlism has become the dominant framework in clinical ethics education precisely because it maps onto the practical structure of healthcare decision-making. For physical therapy practitioners, it offers a particularly useful foundation because the Code of Ethics for the Physical Therapy Profession is itself organized around principles, making the connection between theoretical framework and professional standard unusually direct and transparent.

Section 4: The APTA Code of Ethics for the Physical Therapy Profession

A Landmark 2026 Update

The most significant revision in the history of physical therapy professional ethics took effect on January 1, 2026. On July 14, 2025, the APTA House of Delegates officially adopted the Code of Ethics for the Physical Therapy Profession, a landmark document that fundamentally restructures how the profession articulates its ethical obligations.

What makes this revision a landmark is not merely its updated content but its architecture: for the first time in the profession's history, a single, unified ethical code applies to physical therapists, physical therapist assistants, and students across all roles and practice settings. The former framework — which maintained a separate Code of Ethics for the Physical Therapist (organized around eight principles) and a parallel Standards of Ethical Conduct for the Physical Therapist Assistant (organized around seven standards) — has been retired. In its place stands one document, one set of obligations, one moral community.

This unification reflects a professional consensus that ethical responsibility in physical therapy is not divided by credential or scope of practice. PTs and PTAs work together within a supervisory relationship, share accountability for patient outcomes, and together represent the profession to the public. A unified code expresses the understanding that patient dignity, honest communication, professional accountability, and societal responsibility are the shared foundation of the entire profession.

The new Code applies broadly across all roles in which physical therapy professionals work: patient and client management, consultation, education, research, and administration. Complaints regarding conduct on or after January 1, 2026, are assessed under the new Code; conduct prior to that date may be evaluated under the former documents through December 31, 2027.

Two-Tier Structure: Enforceable Standards and Aspirational Guidance

One of the most important structural features of the new Code is its explicit articulation of two distinct but complementary purposes.

Enforceable Standards of Conduct are identified by numerical designations (e.g., 1.1, 2.3, 4.2) and represent the minimum ethical requirements against which the APTA's Ethics and Judicial Committee (EJC) will assess whether a member has engaged in unethical conduct. These form the basis for formal disciplinary proceedings.

Aspirational Illustrative Examples are identified by alphanumeric designations (e.g., 1.A, 3.D, 5.C) and describe what excellent, values-driven practice looks like beyond the minimum — the behaviors and attitudes that distinguish practitioners who are merely compliant from those genuinely committed to the profession's ideals. These are not enforceable in the sense that a practitioner cannot be disciplined solely for failing to meet them, but they articulate the professional community's aspirations and serve as guideposts for reflective, proactive ethical engagement.

It is equally important to understand that the Code does not prescribe exact actions for every situation. Clinical and professional life is too varied and contextually complex for any code to function as a decision tree. The Code equips the practitioner; it does not replace their reasoning.

The Nine Ethical Commitments

The new Code is organized around nine Ethical Commitments, each representing a domain of professional obligation central to physical therapy practice.

Commitment 1 — Respect establishes the moral bedrock of all that follows: physical therapy professionals shall respect the inherent dignity and rights of all individuals. Enforceable standards prohibit discrimination against any person and require the protection of confidential patient information, permitting disclosure only as authorized or required by law. The aspirational dimensions call on practitioners to acknowledge and actively respect individual identity and cultural context — including recognizing both explicit and implicit personal biases. The Code's explicit acknowledgment of implicit bias as an ethical concern signals that the profession expects its members to engage in honest self-examination, not only in external conduct but in the attitudes and assumptions they bring to every clinical encounter.

Commitment 2 — Integrity addresses professional integrity and legal and ethical obligation. Enforceable standards require the PT to retain full responsibility for all physical therapy services provided under their license, regardless of who delivers them. The ongoing informed consent requirement appears here, as do obligations to report colleagues reasonably believed to be unfit to practice safely, to address known illegal or unethical acts, and to comply with mandatory reporter laws for abuse, neglect, and exploitation. Research participant protection standards reflect the Code's application across professional roles. Aspirationally, this commitment envisions practitioners who actively discourage misconduct and demonstrate integrity across all professional relationships.

Commitment 3 — Accountability requires practitioners to make sound professional judgments within the scope of practice established by law and regulation. Enforceable standards require practitioners to not exceed their scope of practice, to communicate and refer when a patient's needs exceed their competence or authority, and to practice without impairment from substance misuse, cognitive deficiency, or mental illness. A significant aspirational provision calls on practitioners to be accountable for the accuracy of all information they disseminate — explicitly including information shared via social media and generated or assisted by artificial intelligence.

Commitment 4 — Maintaining Professional Relationships addresses the boundaries of professional, therapeutic, organizational, and personal relationships. Enforceable standards include unambiguous prohibitions: no abusive exploitation of patients, students, supervisees, or employees; no sexual relationships with patients, clients, supervisees, or students; no verbal, physical, emotional, or sexual harassment of any kind. The requirement to provide reasonable notice and alternative care sources when terminating a provider relationship reflects the fiduciary nature of the therapeutic relationship. Aspirationally, Commitment 4 calls on practitioners to empower patients in healthcare decision-making, cultivate inclusive and civil work environments, and encourage impaired colleagues to seek assistance.

Commitment 5 — Compassion and Trust focuses on the relational and communicative dimensions of trustworthy practice. Enforceable standards require practitioners to provide patients with the information genuinely needed for informed decision-making, to author clinical documentation and educational materials truthfully and accurately, and to address barriers to communication and comprehension. The aspirational vision pictures practitioners who maintain respectful, accurate, and truthful communication in every form — explicitly including social media.

Commitment 6 — Responsible Business and Organizational Practices addresses the ethical dimensions of business and organizational environments. Enforceable standards prohibit false, deceptive, or misleading billing and business practices; require accurate representation of qualifications and credentials; and prohibit the acceptance or offering of improper financial inducements. Aspirationally, this commitment envisions practitioners as active advocates for ethical organizational practices — willing to report fraudulent billing and committed to promoting cultures of compliance.

Commitment 7 — Direction and Supervision is one of the most significant structural innovations of the new Code, elevating the supervisory relationship to its own Ethical Commitment. Enforceable standards require the PT to maintain supervisory responsibility for all care provided under their license and to ensure that the direction and supervision of PTAs and support personnel comply with applicable laws and regulations. The aspirational dimension calls for clear communication and direction and for ensuring that delegated tasks fall within the supervisee's competence and skill level.

Commitment 8 — Professional Expertise addresses the obligation to engage in career-long learning and maintain professional competence. Enforceable standards require practitioners to maintain and advance their professional knowledge and skills and to accurately represent their areas of competence and qualifications. Aspirationally, Commitment 8 envisions practitioners who pursue lifelong learning with genuine engagement, who mentor students and colleagues, and who ground their practice in evidence.

Commitment 9 — Societal Responsibility places physical therapy professionals within the broader social context of healthcare, calling on them to participate in efforts to meet health needs locally, nationally, and globally. The enforceable standards require practitioners to address societal needs related to physical therapy access and health equity — a significant standard that positions health equity not as an optional advocacy priority but as an enforceable ethical obligation. The aspirational dimension pictures the physical therapy professional as an engaged community citizen who advocates for equitable access to care, engages in public health initiatives and pro bono services, and works toward a more inclusive moral community.

APTA's Core Values

Running beneath all nine Ethical Commitments are the APTA's core values: accountability, altruism, collaboration, compassion and caring, duty, excellence, integrity, and social responsibility. These values are the motivational and dispositional bedrock of ethical practice. If the nine commitments tell practitioners what ethics requires of them, the core values speak to the character from which those requirements should flow. Together, the values describe who practitioners should be, the principles articulate what they owe, and the commitments specify how those obligations are expressed in professional life.

Accountability means accepting responsibility for one's decisions, actions, and their consequences, not only when things go well, but especially when they do not. An accountable practitioner does not deflect blame onto institutional pressures, inadequate staffing, or the actions of others when a patient outcome falls short. They engage honestly with what happened, their role in it, and what should be done differently. Accountability is not self-flagellation; it is the honest, forward-looking recognition that professional authority carries professional responsibility.

Altruism calls on practitioners to place the interests of patients and the public above their own personal gain. This disposition is tested most sharply when economic incentives and patient welfare point in different directions — when seeing one more patient would increase revenue but compromise the quality of care already delivered, when recommending a particular course of treatment serves the practitioner's productivity numbers more than the patient's needs, or when advocating for a patient requires accepting professional discomfort. Altruism does not demand that practitioners be indifferent to their own legitimate interests; it demands that patient welfare remain primary when the two come into conflict.

Collaboration recognizes that physical therapy is rarely practiced in isolation. Good care depends on effective teamwork with PT and PTA colleagues, with other healthcare professionals, and with patients and their families. Collaboration is not merely a practical preference; it is an ethical orientation that acknowledges the limits of any single perspective and the value of bringing multiple forms of knowledge and experience to bear on complex clinical situations. The PT who collaborates well with a supervising physician, communicates clearly with a PTA about a shared patient's progress, and actively involves a patient's family in the plan of care is expressing this value in concrete, daily practice.

Compassion and caring are not merely pleasant interpersonal qualities; they are moral commitments to attending to the suffering, vulnerability, and dignity of the people practitioners serve. Compassion requires more than technical responsiveness to a patient's diagnosis; it requires genuine attentiveness to the person behind the diagnosis — their fears, their goals, the ways in which illness or injury has disrupted their life and sense of self. In practice, compassion shows up in how a practitioner explains a difficult prognosis, how they respond when a patient is frustrated or tearful, and how much care they take to ensure a patient feels seen and respected throughout the course of treatment.

Duty speaks to the binding character of professional obligation, the recognition that choosing a healthcare profession entails accepting responsibilities that are not optional and that persist even when inconvenient or costly. Duty is what makes professional ethics different from personal ethics in an important respect: the obligations of a licensed practitioner are not merely self-imposed commitments that can be renegotiated when circumstances become uncomfortable. They are obligations accepted upon licensure, owed to patients who have no choice but to trust in the system that credentials their providers. A practitioner who fulfills their obligations only when it is easy has not really internalized duty as a value.

Excellence is both a personal commitment to continuous improvement and a professional obligation to the patients who deserve nothing less. Excellence does not mean perfection. It means the relentless pursuit of the highest quality of clinical reasoning, technical skill, communication, and professional judgment that one is capable of bringing to practice. It is expressed in the practitioner who stays current with the evidence base, who seeks feedback on their clinical skills, who reflects honestly on outcomes and asks what might have been done better, and who refuses to allow the routines of busy clinical life to dull the engagement and attentiveness that excellent care requires.

Integrity requires consistency between values and conduct, being the same practitioner in difficult situations as in easy ones, in the presence of oversight as in its absence. Integrity is what prevents the ethical commitments from becoming merely performative — a set of positions practitioners hold in theory but set aside when the costs of acting on them become real. A practitioner of integrity does not document accurately only when an audit seems likely, does not treat patients with respect only when supervisors are watching, and does not advocate for patients only when advocacy is professionally safe. Integrity is the alignment between who a practitioner says they are and who they actually are across all of the varied contexts of professional life.

Social responsibility positions every physical therapy professional as a stakeholder in a just and equitable healthcare system, bearing some measure of accountability for the health of the communities they serve. This value extends the ethical obligations of physical therapy practitioners beyond the walls of their individual practice settings to encompass the broader social conditions that determine who receives care, under what circumstances, and with what quality. Social responsibility is expressed when practitioners advocate for patients who cannot advocate for themselves, when they contribute to community health initiatives, when they speak up about access barriers that affect the populations they serve, and when they engage with the profession's collective voice in calling for healthcare policy that reflects the values the Code articulates.

One important implication of the unified Code is that these core values apply across all professional roles and settings, not only in direct patient care but in education, research, administration, and consultation. A PT serving as a department director who models accountability and integrity in organizational decision-making is expressing these values as fully as one who demonstrates compassion at the bedside. A PTA who brings excellence and duty to a home health visit with a patient in a rural, underserved community is living the profession's values as completely as any practitioner in any setting. The core values are not context-specific virtues; they are the enduring character of the profession, expressed differently across roles but never absent from any of them.

Section 5: Common Ethical and Legal Issues in Physical Therapy Practice

Research consistently confirms that ethical challenges arise routinely in physical therapy practice across all settings and roles (Bertoni et al., 2026; Delany et al., 2019). Among the most frequently encountered ethical issues are: the appropriate use of supervision and support personnel, including ensuring that PTAs and aides practice only within their legal scope and that the supervising PT maintains proper oversight; patient confidentiality and privacy, including the protection of protected health information under HIPAA and the ethical obligations that extend beyond HIPAA's legal minimums; impaired practitioners, including the obligation to recognize and report colleagues whose ability to practice safely may be compromised by substance misuse, physical impairment, or mental health concerns; billing fraud and abuse, including the obligation to document and bill accurately and to report fraudulent practices; and social media and digital ethics, including the risks of unauthorized disclosure of patient information in online environments. The sections that follow address, in detail, the legal and ethical frameworks governing each of these areas.

HIPAA and Patient Privacy

The Health Insurance Portability and Accountability Act, enacted in 1996 and significantly expanded through subsequent regulations, establishes the federal legal framework governing the privacy and security of patient health information. For physical therapists, HIPAA governs decisions made dozens of times each day about how patient information is accessed, stored, shared, and discussed.

Protected Health Information (PHI) is defined as individually identifiable health information created, received, maintained, or transmitted by a covered entity or its business associates. Information becomes PHI when it contains any of eighteen categories of identifiers — including name, geographic data smaller than a state, dates directly related to an individual, phone numbers, email addresses, Social Security numbers, medical record numbers, and photographic images. This means PHI in physical therapy extends far beyond formal medical records. A therapy note, a scheduling message, a photograph used for posture assessment, and a conversation overheard in a clinic waiting room can all involve PHI depending on the circumstances.

The handling of PHI is organized around the principle of minimum necessary use and disclosure — the obligation to access, use, or disclose only the minimum amount of PHI necessary to accomplish the intended purpose. Covered entities must also implement administrative, physical, and technical safeguards to prevent unauthorized access.

Common HIPAA violations in physical therapy include discussing patient information in settings where it can be overheard; leaving a workstation unlocked and unattended while a patient record is open; sharing login credentials; and using standard SMS messaging, which is generally not HIPAA-compliant because it is not encrypted. Social media warrants special attention. Posting about patients online, even without using their name, can constitute a PHI violation if the post contains sufficient detail to allow identification. Photographs or videos posted without proper authorization and commentary about interesting cases that contain identifiable details all create privacy risks.

HIPAA violations carry tiered civil penalties ranging from $100 to $50,000 per violation, with annual caps, and criminal penalties for knowing violations. Beyond formal penalties, violations carry significant reputational and professional consequences, including potential disciplinary action by state licensing boards.

The ethical obligation to protect patient privacy extends beyond HIPAA's legal requirements. Commitment 1 of the new Code establishes the obligation to protect confidential patient information; Commitment 5 requires practitioners to maintain truthful, respectful communication in all forms. Privacy protection is an expression of the fundamental respect and trust that define the therapeutic relationship.

Malpractice and Standard of Care

Malpractice is a form of professional negligence — a civil wrong that occurs when a licensed professional fails to meet the standard of care applicable to their profession, causing harm to a patient. For a malpractice claim to succeed, the plaintiff must establish four elements:

1. Duty — the existence of a professional relationship that gave rise to a legal obligation to provide care
2. Breach — a departure from the applicable standard of care, typically established through expert testimony
3. Causation — a direct causal link between the breach and the harm suffered
4. Damages — actual, quantifiable harm suffered as a result of the breach

The standard of care in physical therapy refers to the degree of care, skill, and treatment that a reasonably competent physical therapist in the same or similar specialty would provide under the same or similar circumstances. This standard is not fixed by statute — it is established through professional consensus, clinical practice guidelines, published evidence, and expert testimony. It is not a standard of perfection; it requires that the practitioner exercise the degree of knowledge, skill, and judgment that a competent professional in their position would exercise.

Common malpractice scenarios in physical therapy include falls during treatment, improper use of therapeutic modalities, failure to refer or escalate, and inadequate documentation. Carrying professional liability insurance is not merely a practical risk management strategy — it is, for most practitioners, both a legal requirement and an ethical responsibility. 

Client Abandonment

Client abandonment is one of the most commonly encountered ethical and legal issues in physical therapy practice and occurs when a practitioner terminates a professional relationship without providing adequate notice or ensuring continuity of care. Abandonment is not limited to abruptly stopping treatment. It also includes withholding patient records when a practitioner leaves a facility, failing to notify the patient or referring provider of a departure, and leaving a patient without a transition plan or access to an alternative provider. Under both the APTA Code of Ethics (Commitment 4) and 844 IAC 6-7-2, practitioners must provide reasonable written notice to both the patient and the referring provider before ending a professional relationship, make arrangements for the transfer of records to the patient's next provider, and comply with a patient's written request for their health records. Providing an interim care plan, assisting with the orientation of a replacement, and informing patients about their departure are examples of appropriate transition practices. Failing to do these things, particularly withholding records or leaving without notice, constitutes client abandonment and can result in disciplinary action.

Commitment 3's accountability standard demands something more than defensive practice. It calls for a genuine commitment to sound judgment, motivated by the patient's welfare rather than by the mere avoidance of liability.

Licensure

Physical therapy practice in the United States is regulated at the state level, with each state maintaining its own licensing authority and physical therapy practice act, the statute that defines the scope of practice, establishes requirements for licensure, and grants authority to the state licensing board to regulate practitioners and take disciplinary action when warranted.

The scope of practice has two dimensions that practitioners must navigate simultaneously. The legal scope of practice is defined by the applicable state practice act. The individual scope of competence is the range of activities for which a specific practitioner has the education, training, experience, and demonstrated proficiency to perform safely and effectively. These two dimensions do not always coincide. The legal scope may permit activities for which a given practitioner has not received adequate preparation, and the ethical obligation to practice within one's competence applies regardless of what the law technically permits.

Maintaining licensure requires ongoing action, including completing required continuing education, submitting timely renewal applications, and, in many states, reporting certain events such as disciplinary action in another jurisdiction or criminal convictions to the licensing board. The Physical Therapy Compact (PT Compact) has achieved broad membership across the United States and allows qualifying practitioners to obtain a compact privilege to practice in member states without undergoing the full endorsement process in each state. The existence of the Compact does not alter the fundamental obligation to hold a valid license or compact privilege in each state where one practices.

Supervision of Physical Therapist Assistants and Support Personnel

The supervisory relationship between physical therapists and physical therapist assistants carries substantial ethical weight — enough that the new Code dedicates an entire Ethical Commitment, Commitment 7, to Direction and Supervision. The PT retains overall responsibility for all physical therapy services provided under their license, regardless of who delivers those services.

Because physical therapy is regulated at the state level, supervision requirements for PTAs, aides, and students vary considerably across jurisdictions in requirements for physical proximity, frequency of required PT-patient contact, documentation requirements, and which activities PTAs may perform. Practitioners must know and follow the supervision requirements of the state in which they practice.

Certain aspects of physical therapy practice, such as evaluation, diagnosis, prognosis, development of the plan of care, and certain reassessment functions, are within the exclusive domain of the PT and cannot be delegated to a PTA regardless of the PTA's experience. Physical therapy aides may perform only non-skilled tasks; delegating skilled interventions to aides is both a legal violation and an ethical failure with direct implications for patient safety.

Documentation in the supervisory relationship must accurately reflect the PT's involvement in plan of care development and reassessment, the PTA's delivery of interventions, and the communication between the two practitioners about the patient's progress. The obligation of veracity applies with full force to the documentation practices of both supervising PTs and the PTAs who document under their supervision.

Disciplinary Action

State licensing boards are empowered to investigate and act on complaints against licensed practitioners when those complaints allege conduct that may constitute grounds for discipline. Grounds typically include incompetence or gross negligence; unprofessional conduct, including fraud, misrepresentation, and dishonesty; violation of the practice act; conviction of a crime substantially related to professional practice; substance abuse affecting the ability to practice safely; and failure to comply with mandatory reporting requirements.

The range of disciplinary actions available to boards includes reprimand, probation, suspension, revocation, and license restrictions. Disciplinary action by a state licensing board is legally and procedurally distinct from professional discipline administered by APTA through its Ethics and Judicial Committee, though both processes may be triggered by the same underlying conduct.

Commitment 2 of the new Code establishes as an enforceable standard the obligation to report colleagues who are reasonably believed to be unfit to practice safely. The standard is a reasonable belief. Practitioners who have genuine, good-faith grounds to believe a colleague is practicing unsafely are ethically and, in many states, legally required to act on that belief, regardless of the personal discomfort involved.

Alongside the obligation to report concerns about others, practitioners carry an ethical duty to self-report certain events, including criminal convictions, disciplinary actions by other licensing jurisdictions, and findings of professional misconduct, to their licensing board within specified timeframes. The duty to self-report is an expression of the accountability and integrity the Code demands.

Fraud and Abuse

In healthcare regulation, fraud and abuse are related but legally distinct concepts. Fraud is intentional misrepresentation.  It is the knowing submission of false information to obtain payment to which the submitting party is not entitled. Abuse refers to practices that are inconsistent with sound fiscal, business, or medical practices and result in unnecessary costs or improper payments, and does not require proof of intent.

Common fraud and abuse scenarios in physical therapy include:

• Billing for services not rendered — submitting claims for treatment sessions that did not occur or for units of service not actually provided
• Upcoding — billing at a higher service level than was actually documented and provided
• Unbundling — billing separately for services that should be billed together under a single bundled code
• Kickbacks and self-referral arrangements — governed by the Anti-Kickback Statute and the Stark Law
• Falsifying documentation — misrepresenting what occurred in a clinical encounter
• Medically unnecessary services — treating patients beyond the point of clinical benefit to maintain billable visits

Federal oversight of healthcare fraud and abuse is primarily the responsibility of the Office of Inspector General (OIG) of the Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS). The consequences of healthcare fraud and abuse are severe: exclusion from Medicare and Medicaid participation, civil monetary penalties that can reach tens of thousands of dollars per false claim (with treble damages available), criminal prosecution resulting in fines and imprisonment, and state licensing board action.

The False Claims Act allows private individuals with knowledge of fraud against the government to file suit on the government's behalf (qui tam provisions) and provides significant legal protections against retaliation for employees who report fraud. Commitment 6 of the new Code aspirationally calls on practitioners to report fraudulent billing and advocate for ethical organizational practices.

Section 6: Emerging Ethical Issues in Physical Therapy Practice

Moral Distress

Moral distress was first described by philosopher Andrew Jameton in the context of nursing practice in 1984 and has since been the subject of substantial research across healthcare disciplines, including physical therapy. It is defined as the psychological suffering that results from knowing the ethically right course of action but being constrained by institutional, systemic, or interpersonal forces from carrying it out.

This definition contains a crucial distinction that sets moral distress apart from ethical dilemmas. In an ethical dilemma, a practitioner faces genuine uncertainty about the right course of action. In moral distress, the practitioner does not lack clarity about what ethics requires. They know what the right thing to do is. The problem is that they cannot do it—or believe they cannot—because of constraints largely beyond their individual control. The suffering of moral distress is not the suffering of uncertainty; it is the suffering of perceived moral powerlessness.

Research confirms that moral distress is not rare among physical therapy practitioners. It is a prevalent feature of clinical professional life, particularly in healthcare environments characterized by productivity pressure, resource limitation, and staffing constraints. The most frequently cited sources include:

• Being required to discharge patients prematurely due to insurance limitations
• Pressure to meet productivity quotas at the expense of quality care
• Witnessing unethical colleague behavior without feeling empowered to report it
• Conflict between institutional policies and patient-centered care

Unaddressed moral distress has serious consequences. Research establishes a significant association between moral distress and emotional exhaustion — a core component of professional burnout. Burnout in healthcare professionals has direct consequences for patient care: a practitioner experiencing emotional exhaustion brings diminished resources to every patient encounter, therapeutic relationships are compromised, and turnover creates organizational losses in continuity and clinical wisdom.

Recognizing moral distress in yourself requires self-awareness. Symptoms can include persistent feelings of guilt or shame about clinical decisions made under constraint, a growing sense that one's professional values and daily work have become disconnected, emotional numbness or detachment in patient interactions, and a preoccupying sense of helplessness in the face of systemic conditions that feel immovable. Moral distress is not a sign of weakness; it is a sign that a practitioner cares enough about their work to suffer when they cannot do it as well as they believe they should.

Responding effectively to moral distress requires action at multiple levels. Peer consultation can significantly reduce the isolation that compounds the suffering of moral distress. Institutional ethics committees, where they exist, provide a formal mechanism for addressing ethically complex situations. Reflective practice and mentorship address the developmental dimension — the need for structured opportunities to process ethical experiences. And engaging with the aspirational commitments of the new Code — particularly Commitments 6 and 9's calls for advocacy — can empower practitioners to recognize that they are not merely obligated to comply with existing conditions but called to advocate for change.

Social Media and Ethical Responsibilities

Social media has transformed the way healthcare professionals communicate, market their services, educate the public, and engage with colleagues and patients. The same technologies that offer genuine opportunities for patient education and professional community building also introduce a distinct and evolving category of ethical risk.

The Code of Ethics for the Physical Therapy Profession, effective January 1, 2026, responds to this need directly, explicitly naming social media as a domain of ethical accountability — a formal professional acknowledgment that the obligations of physical therapy practitioners extend into digital spaces and are subject to the same standards of integrity, accuracy, and patient protection that govern conduct in the clinic.

The most serious category of social media ethical violation involves the sharing of patient information or photographs without proper authorization. This category is broader than many practitioners initially appreciate. It is not limited to posts that explicitly identify a patient by name. A photograph taken in a clinical setting that captures a patient in the background may constitute a PHI disclosure if the patient is identifiable. A description of a clinical case that is sufficiently detailed to allow identification violates privacy, even without a name attached.

Other categories of social media ethical risk include:

• Posting clinical content that could compromise patient dignity or be misinterpreted by lay viewers
• Blurring professional and personal boundaries online — posts made from a personal account can still carry professional implications when the practitioner is identifiable as a physical therapist
• Providing clinical advice to individuals outside a formal therapeutic relationship (the "unsolicited consultation" problem)
• Misleading marketing and credential misrepresentation

The Code addresses social media accountability in two specific provisions. Aspiration 3.D (under Commitment 3) calls on practitioners to be accountable for the accuracy of all information disseminated, explicitly including information shared via social media. Aspiration 5. B (under Commitment 5) calls on practitioners to use respectful, accurate, and truthful communication in all forms, again explicitly including social media.

Key best practices for ethical social media use include never sharing identifiable patient information in any format without proper written authorization; maintaining clear professional boundaries between personal and professional online presence; applying the same standards of truthfulness and accuracy online as in clinical documentation; and pausing before posting to consider whether content could be misused, misinterpreted, or harm the profession's reputation.

Artificial Intelligence and Digital Ethics

Artificial intelligence is no longer a speculative technology — it is an increasingly present feature of the clinical environments in which physical therapy is practiced. Machine learning algorithms, natural language processing systems, computer vision tools, and predictive analytics platforms are being integrated across a widening range of applications: automated documentation systems, movement analysis software, outcome prediction models, and AI-supported telehealth platforms.

For physical therapy practitioners, this integration introduces both a genuine clinical opportunity and a set of ethical obligations that are still being defined. The efficiency gains offered by AI-assisted documentation, the enhanced analytical capacity of predictive outcome tools, and the expanded access to care enabled by AI-supported telehealth are real benefits. But these benefits do not arrive ethically unencumbered.

Accountability is the most practically urgent ethical issue in AI-assisted clinical practice. When a clinical decision supported by an AI tool leads to patient harm, who bears responsibility? Under the current ethical and legal framework, the answer is unambiguous: the licensed physical therapy professional who used the tool and made the clinical decision is responsible. The existence of an AI system does not transfer professional accountability to a software developer or algorithm. Commitment 3 requires practitioners to make sound professional judgments — a standard that applies with full force to decisions made with AI assistance and requires that practitioners not abdicate clinical judgment to algorithmic output simply because a tool presents a recommendation with apparent confidence.

Transparency regarding AI use in patient care is a direct expression of the autonomy principle. Patients generally have not only a reasonable interest in knowing when AI tools are used in their evaluation or treatment planning but an ethical right to that knowledge. Commitment 5's requirement to provide patients with information genuinely needed for informed decision-making applies to AI use when that use is clinically material.

Bias represents one of the most serious ethical concerns introduced by AI in healthcare. AI systems trained on non-representative or historically skewed data produce outputs that are systematically less accurate or less beneficial for underrepresented populations. In physical therapy, an outcome prediction model trained predominantly on a single demographic population may yield inaccurate prognoses for patients from other groups. The ethical obligation to recognize and respond to algorithmic bias flows directly from the principle of justice and from Commitment 1's requirement to respect the inherent dignity and rights of all individuals without discrimination.

Data privacy risks extend beyond familiar HIPAA compliance parameters. AI platforms may transmit patient data to external servers, use patient data for ongoing model training, share data with third-party partners, or retain data in ways that standard clinical data retention policies were not designed to address.

Competence regarding AI tools is required by Commitment 8. This does not require that practitioners develop the technical expertise of AI engineers. It does require a functional understanding sufficient to use AI tools safely — knowing what types of input a tool was designed to process, what populations it was validated on, what types of errors it is prone to, and what clinical signals should prompt the practitioner to set its outputs aside. The field of healthcare AI is evolving rapidly, and AI literacy is an increasingly necessary component of ongoing professional development.

Aspiration 3.D of the new Code explicitly calls on practitioners to be accountable for the accuracy of information generated or assisted by artificial intelligence — applying the same professional standard to AI-assisted clinical documentation, patient education materials, and social media content as to any other professional communication. The practitioner who publishes AI-generated content without verifying its accuracy has failed the accountability standard the Code establishes.

Ethical Issues in Caring for Aging Populations

Physical therapy with older adults is among the most ethically rich domains of clinical practice — not because older patients present more ethical problems, but because the constellation of clinical, relational, and systemic factors characterizing geriatric care creates conditions in which ethical challenges arise with particular frequency, complexity, and consequence.

Decision-making capacity and informed consent present some of the most practically consequential challenges in geriatric physical therapy. Decision-making capacity refers to a patient's ability to understand relevant information, appreciate how it applies to their situation, reason about available options, and communicate a consistent choice. Capacity is decision-specific — a patient may have the capacity to consent to a straightforward exercise program while lacking the capacity to make informed decisions about a complex surgical intervention. It fluctuates with time of day, medication effects, delirium, and pain. The default ethical and legal position is that adult patients retain decision-making capacity, and the burden falls on those who would override a patient's expressed preferences to establish, through careful clinical assessment, that capacity is genuinely impaired.

Surrogate decision-making becomes necessary when a patient's decision-making capacity is genuinely impaired. The ethical complexity arises from the question of the appropriate standard for surrogate decisions. The preferred standard is substituted judgment — the decision the patient would make if they retained capacity, based on their previously expressed values and goals. When prior wishes are unknown, the best interests standard applies. In practice, surrogates frequently make decisions based on their own preferences rather than the patient's, a pattern practitioners can gently address by redirecting conversation toward the patient's own values and previously expressed wishes.

Navigating goals of care when functional improvement is limited requires the kind of honest, compassionate communication that Commitment 5 demands. Providing false hope — allowing patients and families to believe that intensive rehabilitation will produce outcomes the practitioner's clinical judgment does not support — is a violation of the veracity obligation. The courage to have honest conversations about goals of care, framed with genuine compassion and consistent attention to what the patient values most, is one of the most important clinical and ethical competencies in geriatric physical therapy practice.

Recognizing and reporting elder abuse, neglect, and exploitation is an obligation explicitly established by the new Code. Commitment 2, Standard 2.5, requires physical therapy professionals to comply with mandatory reporter laws for abuse, neglect, and exploitation of children and vulnerable adults. The hands-on nature of physical therapy assessment — direct physical contact, detailed functional evaluation, a sustained therapeutic relationship — provides practitioners with observational access that many other members of the care team may not have. Unexplained bruising, patterns of injury inconsistent with reported mechanisms, signs of malnutrition or poor hygiene, a patient who appears fearful in the presence of caregivers, financial exploitation disclosed in the context of a therapeutic relationship — these are signs that may indicate abuse, neglect, or exploitation. The appropriate standard for reporting is not certainty — it is reasonable suspicion. The investigation and determination of what actually occurred is the responsibility of the protective services system; the practitioner's responsibility is to ensure that the system has the information it needs.

Section 7: The RIPS Model of Ethical Decision-Making

Why Structured Decision-Making Matters

Understanding ethical theory and knowing the principles embedded in the Code are necessary foundations for ethical practice — but they are not sufficient. Between knowing what ethics requires in the abstract and responding well to an ethical situation in the clinic lies a set of perceptual and analytical skills that must be systematically applied. The Realm-Individual Process-Situation (RIPS) Model of Ethical Decision-Making, developed by Swisher, Arslanian, and Davis (2005), provides a systematic framework that guides practitioners through the analysis of ethical situations in a way that is both comprehensive and practically applicable.

The value of a structured model lies not in providing predetermined answers, but in the discipline it imposes on the reasoning process. Unstructured ethical reasoning is vulnerable to cognitive and emotional distortions — the tendency to focus on emotionally salient features at the expense of less visible but equally important ones, the pull toward the first defensible option rather than the most defensible one, and the risk of allowing personal discomfort or institutional pressure to substitute for genuine ethical analysis. The RIPS Model provides guardrails against these distortions.

The Four Components of the RIPS Model

Component 1: Realm — Identifying the Domain of the Ethical Situation

The first step is to identify the realm in which the ethical situation primarily occurs. Most complex ethical situations involve more than one realm simultaneously.

The individual realm encompasses the personal and relational dimensions of practice — the patient, the PT, the PTA, family members, and the direct therapeutic relationship among them. Ethical situations in this realm typically involve informed consent, patient autonomy, privacy, communication, and management of the therapeutic relationship.

The organizational or institutional realm encompasses the policies, structures, and practices of healthcare organizations in which physical therapy is delivered, including billing practices, productivity standards, supervision policies, resource allocation, and workplace culture.

The societal realm encompasses the broader social, political, and systemic dimensions of healthcare delivery — health policy, equitable access to care, social determinants of health, and the profession's collective obligations to the public it serves.

Identifying all relevant realms, rather than defaulting to the most immediately obvious one, ensures a more complete analysis of what is at stake and the available responses.

Component 2: Individual Process — Moral Development and Ethical Readiness

The second component directs attention to the practitioner themselves and the capacities they bring to the ethical situation. This component draws on James Rest's moral development framework, which identifies four psychological processes that must occur in sequence for ethical action to result:

Moral sensitivity is the perceptual capacity to recognize that an ethical issue exists in a given situation. A practitioner who lacks moral sensitivity may encounter ethical challenges without recognizing them as such.

Moral judgment is the reasoning capacity to determine what the right course of action is — applying ethical principles, professional standards, and contextual understanding to the specific features of the situation.

Moral motivation is the capacity to prioritize ethical values over competing personal, institutional, or relational interests. Even a practitioner who has recognized an ethical issue and determined the right course of action may be pulled away from ethical action by fear, loyalty, or self-interest.

Moral courage is the capacity to implement ethical action despite the risks — to speak up, report a concern, advocate for a patient, or refuse to participate in unethical conduct even when doing so carries real costs.

Component 3: Situation — Classifying the Type of Ethical Challenge

The third component involves classifying the specific type of ethical situation. Different situation types call for distinct analytical approaches and responses.

Ethical distress (moral distress) occurs when a practitioner knows the right course of action but is constrained from taking it by institutional, systemic, or interpersonal barriers. The challenge is not reasoning toward the right answer but finding the means and courage to act on it, or addressing the constraints that prevent action.

Ethical dilemmas arise when two or more courses of action are each ethically justifiable — when genuine competing obligations point in different directions, and no clearly superior option is apparent. Dilemmas require careful analytical reasoning to determine which option is most defensible.

Ethical temptation occurs when a practitioner faces a situation in which an unethical course of action offers personal benefit and is tempted to pursue it despite knowing it is wrong.

Ethical silence occurs when a practitioner is aware of an ethical issue and fails to speak up or take action. Ethical silence is not merely the absence of action; it is itself a form of ethical conduct with real consequences for patients, colleagues, and the integrity of the profession.

Component 4: Action — Steps Toward Resolution

The fourth component is the structured process of moving from analysis to decision and from decision to implementation through six sequential steps:

1. Gather relevant facts — ensure the practitioner's understanding of the situation is as complete and accurate as possible before proceeding
2. Identify stakeholders — all individuals, groups, and institutions with a legitimate interest in the outcome, including those whose interests may not be immediately apparent
3. Apply ethical principles and the Code of Ethics — bring the analytical frameworks and professional standards to bear on the specific features of the situation
4. Consider options and consequences — identify the full range of available responses and reason through the likely consequences of each for all identified stakeholders
5. Choose and implement a course of action — make a decision and take the concrete steps necessary to carry it out, which requires moral motivation and moral courage
6. Reflect and evaluate outcomes — examine the results of the chosen course of action, consider what worked well and what might have been done differently, and incorporate the learning into ongoing ethical development

Section 8: Applying the RIPS Model — Case Studies

Case Study 1: Supervision and Delegation

The Scenario. A physical therapist in an outpatient neurological rehabilitation clinic assigns a PTA to treat a patient with complex neurological involvement that includes significant spasticity, cognitive impairment, and a recent fall history. The PTA, whose experience is primarily in orthopedic settings, privately believes the patient's needs exceed her current skill level. She expresses her concern to the clinic director, who is not a physical therapist, and is told that the schedule is full, the PT is unavailable, and she should proceed with the patient.

Analysis. The ethical issues are multiple: clinical competence, patient safety, appropriate supervision, and organizational pressure conflicting with professional judgment. The realm spans individual and organizational dimensions. The situation type is ethical distress.  The PTA likely knows what the right course of action is, but is experiencing institutional pressure to ignore that judgment.

Commitment 3 (Accountability) establishes the obligation to practice within one's competence and to communicate and refer when needed. Commitment 7 (Direction and Supervision) requires the PT, not the clinic director, to decide what the PTA is competent to perform. Commitment 2 (Integrity) requires addressing known ethical violations.

Applying the RIPS Action Phase. The PTA must gather facts by clarifying which aspects of this patient's presentation exceed her experience and whether she has communicated those specifics directly to the supervising PT. The appropriate response is not to comply with the clinic director's instruction, but to communicate directly with the supervising PT before proceeding. If the supervising PT is genuinely unreachable and no adequate supervision can be arranged, declining to treat and documenting the circumstances is the most defensible option. This requires the moral courage to assert professional judgment in the face of institutional pressure.

Case Study 2: Billing Fraud

The Scenario. A physical therapist employed at an outpatient practice notices a pattern: patients scheduled for individual physical therapy sessions are consistently treated in groups of four or five, but billing consistently uses individual therapy codes rather than group therapy codes, resulting in significantly higher reimbursement. The PT raises the issue informally with her supervisor, who dismisses her concern and suggests she focus on her clinical responsibilities.

Analysis. This scenario involves one of the most clear-cut categories of healthcare fraud: billing for services not rendered as described. This is not a gray area requiring clinical judgment. It is a systematic misrepresentation to payers that constitutes fraud under federal statutes.

Commitment 2 (Integrity) requires addressing known illegal or unethical acts. Commitment 3 (Accountability) requires compliance with applicable laws. Commitment 6 (Responsible Business Practices) prohibits participation in false billing and aspirationally calls on practitioners to report fraudulent billing and advocate for ethical organizational practices.

Applying the RIPS Action Phase. The PT should document the specific pattern of billing irregularities she has observed. The situation type is ethical distress with elements of ethical temptation. She knows what is right; her initial internal attempt has been rebuffed, and she faces real professional risk if she pursues the matter further. Available options include escalating in writing to the practice owner, consulting a healthcare attorney about False Claims Act protections before taking external action, or filing a report with the relevant payer or the OIG. The option of accepting the supervisor's dismissal as the final word on an ongoing federal crime is not ethically available.

Case Study 3: HIPAA and Social Media

The Scenario. A physical therapist posts a photograph on Instagram of the clinic gym after a busy treatment day, intended to showcase the clinic's equipment and facility. A colleague notices that a patient is visible in the background and is identifiable. The patient's face is clearly visible, and the patient has a distinctive assistive device. The PT did not obtain written authorization from the patient before posting, and the post has been publicly visible for three days.

Analysis. This scenario involves a HIPAA violation of a type increasingly common in an era of routine social media use. The photograph contains PHI — the patient's image in a healthcare setting, combined with visual information about their assistive device. The fact that the patient's presence was incidental rather than intentional does not eliminate the privacy violation; HIPAA does not distinguish between deliberate and inadvertent disclosure of PHI.

The ethical issues extend beyond the legal framework. Commitment 1 (Respect) establishes the patient's right to control how their image and health information appear in public spaces. Aspiration 5. B calls on practitioners to maintain respectful, accurate, and truthful communication on social media. Aspiration 3.D calls for accountability for the accuracy and appropriateness of all information disseminated via social media.

Applying the RIPS Action Phase. Immediate corrective actions include removing the photograph from Instagram, notifying the organization's privacy officer or HIPAA compliance officer promptly, and following the appropriate process for breach risk assessment under HIPAA's Breach Notification Rule — which may require notifying the affected patient. The PT should make direct contact with the patient to acknowledge the error and explain what steps are being taken. Going forward, the PT should establish a personal protocol for reviewing any clinic-related social media content before posting to ensure no PHI is present.

Case Study 4: Impaired Colleague

The Scenario. A physical therapist has observed, on four separate occasions over the past six weeks, that a colleague appears to be impaired at work — exhibiting slurred speech, unsteady gait, and an odor of alcohol on one occasion. On two occasions, the colleague was scheduled to treat patients. The observing PT has not yet raised the concern with anyone, partly because she is uncertain whether she is interpreting the signs correctly, partly because they have a collegial relationship, and partly because she fears the consequences of making an accusation that might be wrong.

Analysis. Commitment 2 (Integrity) contains an enforceable standard requiring practitioners to report colleagues whom they reasonably believe to be unfit to practice safely. The standard is reasonable belief, not certainty, and a practitioner who has observed consistent signs of impairment on multiple occasions over six weeks has more than adequate grounds for reasonable belief. Commitment 1 (Respect) and nonmaleficence establish the patient safety obligation that underlies the reporting requirement.

The situation type is most accurately ethical distress combined with ethical silence: the PT likely knows what the right course of action is, but interpersonal loyalty, uncertainty, and fear of consequences have combined to prevent her from acting for six weeks.

Applying the RIPS Action Phase. Gathering relevant facts means documenting specific, observable behaviors on specific dates — not diagnostic conclusions. Available reporting pathways include raising the concern with the unit supervisor, reporting to the organization's human resources or employee assistance program, contacting the state licensing board, or, in some states, accessing a confidential practitioner assistance program. Most states with mandatory reporting requirements provide some level of immunity from civil liability for practitioners who report in good faith. Implementing the chosen course of action requires accepting that protecting patients from potential harm is more important than protecting a collegial relationship from discomfort.

Case Study 5: Moral Distress and Productivity Pressure

The Scenario. A physical therapist in a skilled nursing facility must meet a daily productivity quota specifying a minimum number of billable treatment units per day. In practice, meeting this quota consistently leaves insufficient time for thorough patient evaluations, meaningful family communication, and complete, accurate documentation. The PT has considered raising the issue with her supervisor but fears it will be perceived as a performance problem and jeopardize her employment.

Analysis. This scenario is ethical distress rather than an ethical dilemma. The PT is not experiencing uncertainty about what ethical practice requires — she knows that thorough evaluation, meaningful family communication, and accurate documentation are components of competent, ethical care. She is experiencing the characteristic suffering of being prevented from providing them by institutional constraints she did not choose.

Commitment 3 (Accountability) establishes the obligation to make sound professional judgments. Commitment 2 (Integrity) requires addressing known ethical concerns. Commitment 6 (Responsible Business Practices) calls for advocacy for ethical organizational practices. Commitment 9 (Societal Responsibility) connects the PT's individual moral distress to a broader professional obligation to advocate for healthcare systems that genuinely serve patients.

Applying the RIPS Action Phase. The PT should document specific clinical impacts in a factual, clinical manner without emotional terms. Available options include raising concerns in writing with her direct supervisor, documenting the impact on patient care, consulting APTA resources on productivity and ethical practice, seeking peer consultation with colleagues who may share her concerns, and consulting a healthcare attorney about whistleblower protections if billing irregularities are also present. Beginning with written communication to her supervisor is both the most directly available step and fulfills the Commitment 2 obligation to address known ethical concerns through available channels before escalating.

Case Study 6: AI-Assisted Documentation

The Scenario. A physical therapist at a busy outpatient practice has been using an AI-powered documentation platform that generates draft clinical notes from brief voice prompts. A colleague reviewing shared patient records notices that several AI-generated notes contain clinical inaccuracies — interventions documented that were not performed, outcome measures recorded that were not administered, and clinical reasoning that does not reflect the patient's actual presentation. When the colleague raises the concern, the PT acknowledges that he has been reviewing the AI-generated notes briefly and signing them without careful verification.

Analysis. The PT has signed clinical documentation that he knows, or should know, contains inaccurate information. Signed clinical documentation constitutes a legal record of what occurred, and inaccurate documentation exposes the PT to malpractice liability, creates risks to patient safety if other providers rely on it, and potentially constitutes fraudulent billing if inaccurate documentation of interventions supports claims for reimbursement. The fact that inaccuracies were generated by an AI system rather than deliberately fabricated by the PT does not eliminate these risks — the PT's signature certifies the documentation's accuracy, and that certification is false.

Commitment 2 (Integrity) applies through the obligation to ensure truthful authorship of clinical documentation. Commitment 3 (Accountability) and Aspiration 3.D specifically address the situation: a practitioner who has allowed an AI tool to substitute for his own professional judgment and verification. Commitment 5 (Compassion and Trust) requires practitioners to author clinical documentation truthfully and accurately.

Applying the RIPS Action Phase. Immediate corrective actions operate at two levels. At the individual level, the PT must review the inaccurate notes already signed and work with the organization's compliance and medical records personnel to determine the appropriate process for correcting or amending them through transparent addenda. At the organizational level, the discovery of systematic documentation inaccuracies from an AI tool is a patient safety and compliance event warranting formal review, including assessment of whether billing submissions require correction or repayment. Going forward, the PT must treat verification of AI-generated content as a non-negotiable professional responsibility and not one that yields to efficiency pressures.

Section 9: Proactive Strategies and Key Resources

Ethics as a Preventive Discipline

Proactive ethics is not a passive state — it is not simply the absence of violations. It is an active, ongoing commitment to developing and maintaining the knowledge, skills, relationships, and habits that enable ethical practice across the full range of circumstances a practitioner will encounter throughout their career.

Develop and maintain personal ethical awareness and moral sensitivity. The foundation of proactive ethical practice is the cultivated capacity to notice ethical dimensions in clinical and professional situations before they escalate. Practitioners who invest in their ethical awareness — who read the ethics literature, reflect on the ethical dimensions of clinical encounters, and engage in conversations with colleagues about the moral texture of their work — develop a finer-grained perception of the ethical landscape, allowing them to identify concerns earlier and respond more thoughtfully.

Maintaining personal ethical awareness also means attending honestly to one's own values, biases, and vulnerabilities. The practitioner who has reflected on their own biases, including implicit biases about patient populations, colleagues from different backgrounds, or organizational contexts, is better positioned to ensure those biases do not distort clinical judgment or ethical reasoning.

Know your state practice act and scope of practice. Thorough, current knowledge of the state practice act and regulations governing your practice is one of the most practically effective proactive strategies available. State practice acts establish the legal scope of practice, define supervisory requirements, specify mandatory reporting obligations, and establish grounds and processes for disciplinary action. A practitioner who regularly reflects on whether their clinical activities fall within their scope of practice and their current level of competence is exercising the kind of proactive accountability that Commitment 3 requires.

Maintain current licensure and competency through continuing education. Maintaining current licensure requires attention to renewal deadlines, continuing education requirements, and any reporting obligations imposed by the practice act. Beyond minimum requirements, proactive competency development means pursuing continuing education that genuinely advances clinical knowledge and professional capability rather than merely accumulating required hours. This includes deliberate investment in competencies newly relevant to contemporary practice — AI literacy, social media ethics, and the emerging issues addressed in this course.

Document thoroughly, accurately, and promptly.  This includes AI-generated content. Clinical documentation is simultaneously a legal record, a communication tool for the care team, a basis for reimbursement claims, and an expression of professional integrity. The specific obligation to review AI-generated documentation before signing, highlighted in Commitment 3's Aspiration 3.D, warrants particular emphasis. A signed clinical note carries the practitioner's professional and legal certification of its accuracy; that certification is meaningful only if the practitioner has actually verified the content.

Establish clear communication with patients, families, and colleagues. Many ethical challenges stem from communication failures. Proactive ethical practice means investing in the quality and clarity of professional communication as a preventive measure — ensuring that informed consent is genuinely ongoing rather than a one-time intake formality, and establishing explicit understandings with colleagues about supervisory expectations, clinical responsibilities, and the channels for raising concerns.

Create a culture of compliance within your practice setting. Individual ethical practice occurs within organizational contexts that either support or undermine it. A culture of compliance is one in which ethical practice is understood as a shared professional value, concerns can be raised without fear of retaliation, policies are transparent and consistently applied, and the gap between stated values and actual conduct is treated as a problem worth addressing. Contributing to this culture means modeling the ethical practices one wishes to see in colleagues, creating opportunities to discuss ethical challenges in a supportive environment, and being willing to speak up when organizational practices depart from ethical standards.

Seek supervision, mentorship, and peer consultation when uncertain. The willingness to seek consultation when facing uncertainty is one of the most consistently underutilized proactive strategies in ethical practice. Peer consultation provides the perspective of someone who shares the practitioner's professional framework but who is not embedded in the specific relational and institutional dynamics of the situation. Mentorship by experienced practitioners offers the additional benefit of accumulated practical wisdom.

Use responsible judgment with social media and AI tools. For social media, establish personal policies that embed ethical standards into digital professional conduct before problems arise; maintain a clear mental model of which information is appropriate to share, review clinical-setting photographs before posting, and treat any uncertainty about a post as a signal to pause rather than proceed. For AI tools, approach every AI-assisted clinical function with the understanding that the practitioner's professional judgment and verification responsibility are not transferred to the algorithm.

Recognize and address moral distress proactively. The commitment to recognize the signs of moral distress in yourself and in colleagues — and to seek support proactively rather than waiting for distress to reach the level of burnout before responding — is the most personally demanding proactive strategy addressed here. Moral distress is a prevalent and consequential feature of physical therapy professional life. Proactive recognition means developing the self-awareness to notice when persistent feelings of powerlessness, frustration, or ethical dissatisfaction are accumulating in response to workplace conditions, and treating those feelings as clinically significant signals rather than personal weaknesses to be managed in silence.

Recognizing Warning Signs

Proactive ethical practice requires not only self-monitoring but environmental monitoring. The capacity to recognize when the practice setting itself is generating conditions that place practitioners and patients at ethical risk.

Warning signs include:

• Pressure from employers or payers to alter documentation or exceed the scope of practice. Requests to document services differently from how they occurred are requests to participate in fraud and falsification of records. These requests should never be complied with, regardless of how they are framed or who makes them.
• Vague or absent policies for billing, supervision, and patient care. Organizations that have not developed clear, written policies in these areas lack the structural guardrails that protect practitioners from being inadvertently drawn into compliance violations.
• Retaliation for raising ethical concerns. When a practitioner who raises a legitimate concern is met with negative performance evaluations, schedule changes, or social exclusion rather than genuine engagement with the substance of the concern, the organizational environment has signaled that ethical compliance is less valued than silence.
• Persistent feelings of powerlessness, frustration, or exhaustion related to workplace ethical conflicts — the internal signal that moral distress has reached a level that requires active response.

Key Resources

The new APTA Code of Ethics for the Physical Therapy Profession (2026) is available at apta.org and is the foundational document to which all ethical analysis in this course has been anchored. Practitioners will benefit from reading it regularly throughout their careers.

The APTA Ethics and Judicial Committee (EJC) interprets and enforces the Code of Ethics for APTA members, serves as the adjudicative body for formal complaints about member conduct, and provides consultation and guidance to practitioners navigating ethical questions. Contact them at [email protected]. This resource should be treated as a normal feature of professional practice, not a step reserved for formally adversarial situations.

APTA Practice Advisories and Guidance Documents address specific clinical, regulatory, and ethical issues — including documentation, supervision, billing compliance, telehealth, and the use of emerging technologies — and are regularly updated to reflect changes in regulation, technology, and professional standards.

State Licensing Boards are the regulatory authorities with primary jurisdiction over physical therapy licensure and professional conduct in each state. Practitioners with questions about state-specific scope of practice, supervision requirements, mandatory reporting obligations, or disciplinary processes should consult their state licensing board directly.

The HHS Office for Civil Rights (OCR) is the federal agency responsible for enforcing HIPAA's Privacy and Security Rules and for receiving and investigating HIPAA complaints. Guidance and complaint-filing resources are available on the OCR website and via the helpline.

The OIG Compliance Resources at oig.hhs.gov include guidance, model compliance program documents, advisory opinions, and enforcement information relevant to healthcare fraud and abuse prevention. The OIG's annual Work Plan identifies fraud and abuse issues the agency intends to prioritize for investigation — an important reference for practitioners seeking to understand where enforcement attention is focused.

The PT Compact at ptcompact.org provides information about the Interstate Physical Therapy Licensure Compact, including current member state status, eligibility requirements, and application processes.

Risk Management Consultation through professional liability insurance carriers is a resource practitioners often underutilize, associating it with reactive claim management rather than proactive prevention. Most carriers provide policyholders with access to risk management consultation services, including advice on documentation practices, supervision arrangements, scope-of-practice questions, and HIPAA compliance.

Employee Assistance Programs (EAPs) are employer-sponsored programs that provide confidential support services to employees facing personal and professional challenges. For practitioners experiencing moral distress, navigating a whistleblower situation, or struggling with the emotional consequences of workplace ethical conflicts, EAP services can provide important support.

Institutional Ethics Committees exist in many hospital and health system settings to provide case consultation, policy guidance, and educational support on ethical issues arising in clinical care. Practitioners should identify whether this resource exists in their setting proactively before a situation arises in which it is needed.

A Final Word: Ethics as a Career-Long Commitment

Ethics is not peripheral to physical therapy practice. It is foundational to it. Every patient who seeks care from a PT or PTA places trust in the practitioner to act with integrity, honesty, and genuine commitment to their well-being. Honoring that trust requires more than technical competence; it requires ethical knowledge, judgment, and courage.

The landmark Code of Ethics for the Physical Therapy Profession, effective January 1, 2026, establishes a single unified ethical standard for all PTs, PTAs, and students through nine Ethical Commitments — each carrying enforceable standards that define the floor of acceptable conduct and aspirational guidance that describes the ceiling of excellent practice. That Code directly addresses the full range of ethical obligations examined in this course: the legal foundations of privacy, malpractice, licensure, supervision, and fraud; the emerging challenges of moral distress, social media, artificial intelligence, and geriatric care; and the profession's collective responsibility to advocate for equitable, patient-centered care at every level of the healthcare system.

Navigating that complexity requires both principled frameworks and structured analytical tools. The foundational principles of autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity provide the moral language for identifying what is at stake, while the RIPS Model provides a consistent, defensible process for moving from recognition to analysis to action. Used together, they equip practitioners to make ethical decisions that are transparent, well-reasoned, and grounded in the profession's deepest values, even when those decisions are difficult, and the consequences of acting on them are real.

This course has aimed to cultivate ethical awareness, a shared conceptual vocabulary, analytical skills, and the professional orientation that will allow you to navigate unfamiliar ethical terrain with integrity and confidence. The most effective protection against ethical failure is ultimately proactive rather than reactive. Practitioners who invest continuously in their ethical awareness, maintain current knowledge of the Code and their state practice act, document accurately, communicate clearly, cultivate cultures of compliance, recognize the signs of moral distress, and access the professional and institutional resources available to them are not merely avoiding violations; they are actively promoting ethical practice. They are fulfilling the professional identity that licensure represents and that patients deserve.

Ethics is not a body of knowledge to be acquired and then applied mechanically. It is a practice, a daily commitment to bringing your best judgment, your most honest reflection, and your deepest professional values to the work of caring for patients. The Code of Ethics for the Physical Therapy Profession speaks with a single unified voice to every physical therapy practitioner (PT, PTA, and student), affirming that ethical responsibility is not divided by credential or role but is shared across the entire professional community. In accepting that responsibility, you join a moral community whose members have committed, collectively and individually, to practicing with integrity, compassion, accountability, and respect for the dignity of every person they serve.

References

• Aguilar-Rodríguez, M., Kulju, K., Hernández-Guillén, D., Mármol-López, M. I., Querol-Giner, F., & Marques-Sule, E. (2021). Physiotherapy students' experiences about ethical situations encountered in clinical practices. International Journal of Environmental Research and Public Health, 18(16), 8489. doi: 10.3390/ijerph18168489
• American Physical Therapy Association. (2026). Code of ethics for the physical therapy profession. https://www.apta.org/apta-and-you/leadership-and-governance/policies/code-of-ethics
• Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.
• Bertoni, G., Manzati, S. P., Pagani, F., Testa, M., & Battista, S. (2026). Ethical and bioethical issues in physical therapy: A systematic scoping review. Physical Therapy, pzag011.
• Delany, C., Edwards, I., & Fryer, C. (2019). How physiotherapists perceive, interpret, and respond to the ethical dimensions of practice: A qualitative study. Physiotherapy Theory and Practice, 35(7), 663–676.
• Inbar, N., Doron, I. I., & Laufer, Y. (2024). Physiotherapists' moral distress: Mixed-method study reveals new insights. Nursing Ethics, 31(8), 1537–1550. doi: 10.1177/09697330241230512
• Lemersre, P., Gervais-Hupé, J., Carrier, A., Bourges, N., Mathieu-Fritz, A., & Hudon, A. (2025). Physical therapy and social media: Protocol for a critical interpretive synthesis of ethical and social issues. JOSPT Methods, 1(3), 96–101.
• Mohapatra, A., Mohanty, P., Pattnaik, M., & Padhan, S. (2024). Physiotherapy in the digital age: A narrative review of the paradigm shift driven by the integration of artificial intelligence and machine learning. Physiotherapy-The Journal of Indian Association of Physiotherapists, 18(2), 63–71.
• Orgambídez, A., Borrego, Y., Alcalde, F. J., & Durán, A. (2025). Moral distress and emotional exhaustion in healthcare professionals: A systematic review and meta-analysis. Healthcare, 13(4), 393. doi: 10.3390/healthcare13040393
• Richardson, R. W. (2015). Ethical issues in physical therapy. Current Reviews in Musculoskeletal Medicine, 8(2), 118–121. doi: 10.1007/s12178-015-9266-y
• Sousa, J. L., Gonçalves-Lopes, S., & Abreu, V. (2021). Ageing and ethical challenges in physiotherapy: Application of the RIPS model in ethical decision-making. Annals of Medicine, 53(1), 188–192. doi: 10.1080/07853890.2021.1896437
• Swisher L, Arslanian L, Davis C. The Realm-Individual Process-Situation (RIPS) model of ethical decision making. HPA Resour. 2005;5(3):1, 3–8.

Learning Outcomes-Jurisprudence Segment

After this course, participants will be able to:

• List two sources of law that govern physical therapy practice in Indiana.
• Identify the clinical scope of physical therapy practice in Indiana as defined by the most recent Indiana Physical Therapy Practice Act.
• Describe how to maintain and renew their Physical Therapy license, including continuing competence requirements needed for license renewal.

Section 1: Introduction to Jurisprudence and Why It Matters to You

What Is Jurisprudence, and Why Should You Care?

You chose a career in physical therapy to help people move better, recover from injury, and live more fully. You probably did not choose it to become an expert in legal documents. That is completely understandable---but here is the reality: if you hold a physical therapy license in Indiana, you are legally responsible for knowing the rules that govern your practice. That body of rules is what we call jurisprudence.

In simple terms, jurisprudence is the body of laws and regulations that govern who can practice physical therapy, what they are allowed to do, how they must behave, and what happens if they do not follow the rules. Think of it as the rulebook for your profession.

You might be wondering why a clinician needs to spend time studying legal text. Here are three straightforward reasons.

It protects your patients. Every rule in Indiana's physical therapy laws exists, first and foremost, to keep patients safe. When you understand the law, you are better equipped to deliver safe, ethical, and trustworthy care.

It protects your license. Your license is the foundation of your career. The laws and rules we will cover today are not suggestions; they are requirements. Violating them, even unintentionally, can put your license in jeopardy. Knowing the rules helps you avoid costly mistakes.

The rules change. Indiana's laws and regulations are updated regularly. It is your responsibility as a licensee to stay current. The best way to do that is to bookmark the Indiana Professional Licensing Agency's website at https://www.in.gov/pla/professions/physical-therapy-home/ and check it periodically. The American Physical Therapy Association (APTA) at https://www.apta.org/your-practice/scope-of-practice is also a helpful resource.

Where Does Physical Therapy Law in Indiana Come From?

Indiana's physical therapy laws come from a few different places, and it helps to know the difference between them.

Statutes are laws passed by the Indiana General Assembly, the state legislature. They are the highest level of authority we will discuss. Statutes tell us in broad terms what physical therapy is, who can practice it, and what the consequences are for violating the rules.

Administrative rules are more detailed regulations created by the Indiana Board of Physical Therapy. The legislature grants the board the authority to write these rules, and they carry the same legal weight as statutes. Rules fill in the practical details that statutes leave out, such as exactly how many continuing education hours you need and how supervisory visits must be documented.

Scope-of-practice rulings are interpretive documents issued by the board to clarify how specific laws apply to specific situations. They are posted on the board's website and are important to read, especially when new treatment techniques or practice questions arise.

Throughout this course, we will work through all of these sources in a logical order. Let us get started.

Section 2: Indiana Code Title 25, Article 27, Chapter 1 — The Physical Therapy Practice Act

What Is the Practice Act?

The Indiana Physical Therapy Practice Act is the primary law governing physical therapy in Indiana. It is found in Indiana Code 25-27. You are encouraged to read the full text of the Practice Act on your own, as this course is a thorough overview, but nothing replaces reading the actual law. You can find it at https://iga.in.gov/laws/2023/ic/titles/25#25-27.

Definitions That Matter (IC 25-27-1-1)

Before we get into the rules themselves, we need to establish a common vocabulary. The definitions below are not just helpful; they are legally binding. When the law uses these terms, these are exactly what they mean.

Physical therapy is defined broadly. It includes examining and evaluating patients; developing diagnoses and treatment plans; hands-on interventions like manual therapy, therapeutic exercise, and wound care; the use of physical agents and modalities; and patient education. It also includes dry needling (with proper training---more on that later), wellness and injury prevention, and activities like administration, consulting, teaching, and research.

Physical therapist means a person who holds a valid Indiana license to practice physical therapy.

Physical therapist assistant (PTA) means a person who holds a valid Indiana certificate and assists a physical therapist with selected components of treatment.

Board refers to the Indiana Board of Physical Therapy---the regulatory body that oversees the profession.

Physical therapy aide means support staff who perform designated tasks related to the operation of physical therapy services. Aides do not make clinical decisions.

Sharp debridement means removing dead or foreign tissue from around a wound using sharp instruments like a scalpel or scissors, without anesthesia and generally without significant bleeding, to expose healthy tissue and promote healing.

Spinal manipulation means using a direct thrust to move a joint of the patient's spine beyond its normal range of motion, without going past the limits of what the anatomy can safely handle. This technique has specific referral requirements, discussed below.

Tasks are activities that do not require the clinical judgment of a PT or the clinical problem-solving of a PTA. These are the kinds of things aides can perform.

Competence means having and applying the knowledge, skills, and behaviors needed to practice safely, ethically, and legally.

Continuing competence means actively maintaining and documenting your skills over time through self-assessment, learning, and ongoing practice.

State, for the purposes of Indiana law, includes U.S. territories, the District of Columbia, and Puerto Rico.

Direct supervision means the supervising PT or PTA is physically present in the same location and immediately available to step in.

General supervision means the supervising PT is reachable by phone or another form of telecommunication; they do not need to be physically present.

Onsite supervision means the supervising PT is continuously present in the facility or department, immediately available to the person they are supervising, and actively involved in the relevant aspects of patient care.

Conduct testing refers to the standard methods used to gather patient data, including electrodiagnostic and electrophysiologic tests. It does not include x-rays.

Physical therapy diagnosis is the outcome of a systematic evaluation process that identifies the dysfunction being treated. It is not the same as a medical diagnosis.

What Is Unlawful? (IC 25-27-1-2)

This section spells out what you cannot do without a license and what even licensed practitioners cannot do without following specific rules.

Without a license, it is illegal to:

• Practice physical therapy in Indiana.
• Call yourself a physical therapist or use titles like "P.T.," "D.P.T.," "L.P.T.," "R.P.T.," or any similar designation, unless physical therapy is actually being provided by or under the direction of a licensed PT.
• Advertise physical therapy services unless the person providing those services is a licensed physical therapist.

For licensed PTs and certified PTAs:

Physical therapy must generally be provided based on a referral or order from an authorized provider. Those authorized providers include physicians, podiatrists, psychologists, chiropractors, dentists, advanced practice registered nurses (APNs), and physician assistants who hold an unlimited license in their respective fields. Note: optometrists are not included among authorized referring providers under Indiana law.

There are exceptions, specifically, the direct access rules described in the next section.

PTAs must practice under the general supervision of a licensed physical therapist. They cannot work independently. However, other healthcare providers who are licensed under separate Indiana laws, such as osteopathic physicians, chiropractors, and podiatrists, are not restricted by the physical therapy practice act when they are practicing within their own scope.

PTs and PTAs are also not authorized by this act to evaluate physical disabilities or mental disorders without a referral from an authorized provider, to practice medicine or surgery, dentistry, optometry, or any other separately licensed healthcare profession, or to prescribe medications.

One specific exception worth noting: a licensed PT who works as an employee or contractor for a school corporation can provide mandated school services to a student when referred by a licensed school psychologist, even without a standard provider referral.

Direct Access: Treating Patients Without a Referral (IC 25-27-1-2.5)

Indiana allows physical therapists to evaluate and treat patients without a referral for up to 42 calendar days, starting from the first day of treatment. This is called direct access.

Here is what that means practically: a patient can walk into your clinic, you can evaluate them and begin treatment, and you do not need a physician's order to get started. However, if that patient still needs physical therapy after 42 days, you must obtain a referral from an authorized provider before continuing.

Two important restrictions apply:

Spinal manipulation is not allowed under direct access. To perform spinal manipulation, you need a specific order or referral from a physician, an osteopathic physician, or a chiropractor. Additionally, the referring provider must have personally examined the patient before writing the order. Both conditions must be met; you need the right referral source, and that provider must have seen the patient first.

Electrodiagnostic and electrophysiologic testing require a specialty certification. If you want to perform these tests, you must first obtain and maintain the American Board of Physical Therapy Specialties (ABPTS) Clinical Electrophysiologic Specialist Certification.

What Is Still Allowed for Others? (IC 25-27-1-3.1)

The Practice Act is clear that it does not restrict other licensed healthcare providers from doing what they are legally permitted to do in their own scopes of practice. Osteopathic physicians, chiropractors, and podiatrists can continue practicing within the scope of their licenses. Anyone can provide first aid in an emergency. Chiropractors licensed in Indiana can provide physical therapy modalities, physical rehabilitation services, therapeutic procedures, tests and measurements, and physiotherapy — so long as they do not advertise these services as physical therapy.

Who Is Exempt from Indiana Licensure? (IC 25-27-1-3.3)

Certain people do not need an Indiana license to practice physical therapy here, under specific conditions:

• Students in clinical rotations. A person enrolled in a board-approved entry-level PT or PTA education program who is completing supervised clinical education requirements is exempt, as long as a licensed PT is providing onsite supervision throughout.
• Military physical therapists. PTs employed by the U.S. Armed Forces, the U.S. Public Health Service, or the Department of Veterans Affairs who are practicing under federal regulations for jurisdiction licensure do not need an Indiana license. However, if that same person practices physical therapy outside the course and scope of their federal employment while in Indiana, they must obtain an Indiana license.
• Out-of-state PTs teaching educational seminars. A PT licensed in another state, or credentialed to practice in another country, who is teaching, demonstrating, or providing physical therapy services in connection with an educational seminar is exempt for up to 60 days per calendar year.
• PTs traveling with athletic teams or performing arts companies. A PT licensed in another state, or credentialed in another country, who is providing physical therapy by contract or employment to patients affiliated with or employed by an established athletic team, athletic organization, or performing arts company that is temporarily practicing, competing, or performing in Indiana, is exempt for up to 60 days per calendar year. Note that a separate statute, IC 25-1-15, also addresses this situation with different conditions and a shorter 30-day limit — see that section for an important distinction.
• Out-of-state PTs helping during a declared disaster. A PT licensed in another state who provides physical therapy during a declared local or national disaster or emergency is exempt for up to 60 days following the emergency declaration. To qualify, the PT must notify the board of their intent to practice before doing so.
• Out-of-state PTs displaced by a disaster. A PT licensed in another state who is forced to leave their home or place of employment due to a declared local or national disaster or emergency and seeks to practice physical therapy in Indiana as a result is exempt for up to 60 days following the emergency declaration. Board notification of intent to practice is required.
• PTAs assisting in these situations. A PTA who is licensed or certified in another state and who is assisting a physical therapist engaged specifically in the military, educational seminar, athletic team, or disaster-related activities described above is also exempt from Indiana licensure requirements under the same conditions that apply to the PT they are assisting.

Sharp Debridement Requires a Referral (IC 25-27-1-3.5)

Sharp debridement requires a referral or an order from a physician, osteopath, or podiatrist. There are no exceptions to this rule in Indiana — no matter how skilled you are in wound care, you must have that referral before proceeding with sharp debridement.

The Indiana Board of Physical Therapy (IC 25-27-1-4)

The Indiana Board of Physical Therapy is the official regulatory body that oversees physical therapy practice in Indiana. 

The board has five members: three licensed physical therapists, one certified physical therapist assistant, and one Indiana resident who is not involved in physical therapy in any capacity other than as a patient or consumer. Board members are appointed by the governor for four-year terms, and no one can serve more than eight years in any ten-year period. PT and PTA members must hold unrestricted licenses, have at least five years of active practice experience before being appointed, and continue practicing in Indiana while serving on the board. Any action taken by the board requires a majority vote, and the board meets at least four times per year.

It is worth clarifying that the Indiana Board of Physical Therapy and the Indiana Physical Therapy Association (INAPTA) are two separate organizations. The board's mission is to protect the public by regulating the profession. INAPTA's mission is to advance the profession and improve the health of Hoosiers through advocacy, education, and collaboration. Both are important, but they serve different purposes. The board's meeting minutes, agendas, and disciplinary records are available to the public on the board's website.

What the Board Is Responsible For (IC 25-27-1-5)

The Board of Physical Therapy is responsible for:

• Reviewing applications and determining whether applicants meet the qualifications for licensure or certification.
• Overseeing all licensing examinations, either directly or through an approved testing organization.
• Determining who passes those exams.
• Issuing licenses to PTs and certificates to PTAs.
• Writing and updating the rules that define what competent practice looks like.
• Setting continuing competency requirements for license and certificate renewal.

Getting Your License (IC 25-27-1-6 through IC 25-27-1-6.4)

To apply for a physical therapy license or PTA certificate in Indiana, you must:

• Complete the application and pay the required fees.
• Provide proof of graduation from an accredited PT or PTA education program.
• Pass the licensing examination.
• Submit to a national criminal history background check.
• Confirm that you have no convictions that would directly affect your ability to practice safely, and that no other state has taken disciplinary action against you for posing a risk to the public.

If you were educated outside the United States, you must do all of the above plus provide evidence that your education is substantially equivalent to that of a graduate from a U.S.-accredited program. This can be done by graduating from a foreign program accredited by the same U.S.-recognized accrediting body, or by undergoing a credentials evaluation as directed by the board. You may also be required to pass a board-approved English proficiency examination and complete supervised clinical practice under a restricted license.

If the board denies your application, you have 15 days from receiving that notification to appeal. An administrative hearing will then be scheduled.

The Licensing Examination (IC 25-27-1-7)

The majority of readers of this text course are already licensed and have knowledge on this topic, but it is still good to review, if you have clinical students in the future. 

The PT examination tests entry-level competence across all aspects of physical therapy, including theory, evaluation, diagnosis, prognosis, treatment, prevention, and consultation. The PTA examination tests the knowledge and skills needed for the technical application of physical therapy services.

The exam can be taken up to 6 times. You must agree to the examination's security and copyright terms. If the board finds that you attempted to cheat on or otherwise undermine the integrity of the exam, you can be disqualified temporarily or permanently from taking it. Any violation will also be reported to the Federation of State Boards of Physical Therapy (FSBPT).

Your License: Renewal, Reinstatement, Temporary Permits, and Retirement (IC 25-27-1-8)

Renewal

Your license or certificate expires on June 30 of each even-numbered year. You must pay your renewal fee by that date. If you miss it, your license automatically becomes invalid---the board does not need to take any additional steps to suspend it.

Reinstatement

If your license has expired, you can reinstate it within three years of the expiration date by paying the penalty fee and renewal fees and providing evidence of continuing competency. If your license has expired for more than three years, the board may require you to be re-examined. Current reinstatement requirements (which are posted on the board's website and subject to change) include a reinstatement fee, a completed reinstatement form, a letter explaining your work history since your Indiana license expired, verification of any other state licenses you hold, and proof of 22 hours of continuing education (including 2 hours in ethics and Indiana jurisprudence) completed within the past 24 months.

Temporary permits

The board will not issue more than two temporary permits to any single PT or PTA. A temporary permit allows you to practice only under the on-site supervision of a licensed PT who is responsible for patient care. A temporary permit is available if you hold a valid PT license or PTA certificate from another state, or if the board has approved you to take the exam and you have not previously failed it. A temporary permit expires when you become licensed or certified, when your application is approved by endorsement, or when your application is denied, or you fail the exam, whichever happens first.

Retirement

If you decide to retire, notify the board in writing. The board will update your record to reflect retired status, and you will no longer need to pay renewal fees. If you later want to return to practice, submit a written request to the board. The board has the authority to set whatever conditions it deems appropriate for reinstatement. If any disciplinary action is pending against you, you cannot surrender your license without the board's written consent.

Getting Licensed by Endorsement from Another State (IC 25-27-1-9)

If you are already licensed as a PT or certified as a PTA in another state, you may be able to obtain an Indiana license by endorsement, meaning Indiana recognizes your out-of-state license without requiring you to start the entire licensing process from scratch. To qualify, you must meet the same general requirements as any Indiana applicant, have passed a licensing examination that is equal to or exceeds Indiana's standards, and pay the applicable fee. You must also confirm that you have no disqualifying criminal convictions and have not had disciplinary action taken against you in any other state.

Physical Therapist Responsibilities and Supervision (IC 25-27-1-13)

As a physical therapist, you are responsible for managing every aspect of the physical therapy care your patients receive. Specifically, this means you must:

• Perform the initial evaluation, establish a PT diagnosis and prognosis, develop the plan of care, and document every patient encounter.
• Periodically re-evaluate each patient and document their progress.
• Complete and document a formal discharge, including the patient's response to treatment.
• Personally provide any treatment that requires a PT's level of education, knowledge, and skill.
• Make thoughtful decisions about when and how to involve PTAs in patient care.
• Verify the qualifications of all PTAs and aides working under your supervision.

PTAs work under a PT's supervision. They must document the care they provide.

Physical therapy aides may only perform designated tasks — tasks specifically assigned to them by a PT or PTA. Aides must have direct supervision from a physical therapist at all times during patient-related tasks.

Documentation and Billing (IC 25-27-1-14)

Both PTs and PTAs are personally responsible for accurately documenting and billing for the services they provide. This is not just a workplace policy; it is a legal obligation. Inaccurate documentation or billing can constitute fraud, which is a serious violation.

Communicating the Plan of Care (IC 25-27-1-15)

Before carrying out a plan of care, you must communicate it to the patient or, when appropriate, the patient's legal representative. This is about respecting patients' rights and ensuring they understand and agree with the care they are receiving.

Patient Confidentiality (IC 25-27-1-17)

Information about a patient that you learn in the course of providing care, such as their diagnosis, treatment, progress, and any personal details they share, is confidential. You may not share it with anyone who is not involved in that patient's care unless the law requires you to or the patient gives you written permission to do so. This applies to conversations, written records, and electronic communications.

Displaying Your License (IC 25-27-1-18)

You are required to display a copy of your license or certificate in a location where patients can easily see it. You must also be able to either provide a copy of your license when asked or tell a patient how to verify your credentials online through the Indiana Professional Licensing Agency's website.

Indiana Code Title 25, Article 27, Chapter 2 — The Physical Therapy Licensure Compact

What Is the Compact and Why Does It Exist? (IC 25-27-2-1)

If you have ever treated a patient via telehealth who was in another state, or worked with an athletic team traveling across state lines, you have probably considered multistate licensing. The Physical Therapy Licensure Compact (PTLC) was created to make practicing across state lines easier for both practitioners and patients.

Indiana became a fully participating compact state on April 20, 2023.

The compact is built on a straightforward idea: physical therapy practice occurs in the state where the patient is located. So if you are in Indiana treating a patient who is physically in Ohio via telehealth, you are legally practicing in Ohio — and you need to be authorized to practice there.

The compact creates a streamlined way for licensed PTs and PTAs to practice in other participating states without going through the full individual state licensing process each time. At the same time, each state keeps its authority to protect patients within its borders.

The compact is designed to:

• Expand public access to physical therapy services by allowing PTs and PTAs to practice more easily across state lines.
• Help military spouses who frequently relocate maintain their ability to practice.
• Create a shared system for tracking licensure, disciplinary actions, and investigations across all member states.
• Allow any member state to hold practitioners accountable to its standards, even when those practitioners are licensed elsewhere.

Key Compact Terms You Need to Know (IC 25-27-2-2)

• Compact privilege — The authorization that a "remote state" (any participating state that is not your home state) grants you to practice there without having to get a separate full license. Think of it as a pass that your home state license enables.
• Home state — The participating state where you live as your primary residence. This is the state that holds authority over your license.
• Remote state — Any participating state other than your home state where you want to practice using your compact privilege.
• Encumbered license — A license that has been limited, restricted, or conditioned in any way by a licensing board.
• Adverse action — Formal disciplinary action taken by a licensing board based on misconduct or substandard performance.
• Alternative program — A non-disciplinary monitoring or remediation process---for example, a substance abuse recovery program---that a board may use in place of formal discipline.
• Data system — The shared database maintained by the Compact Commission that tracks licensure, adverse actions, and investigation information for all practitioners across member states.
• Physical Therapy Compact Commission — The national administrative body that runs the compact, made up of member states.

What Your State Must Do to Participate (IC 25-27-2-3)

For Indiana to participate in the compact, it must meet these requirements: actively participate in the Compact Commission's data system; have a process for receiving and investigating complaints about licensees; use the National Physical Therapy Examination (NPTE); comply with all Commission rules; require continuing competence for license renewal; and conduct criminal background checks using FBI fingerprint-based records for all new licensure applicants.

How to Get and Keep a Compact Privilege (IC 25-27-2-4)

To practice in another compact state using your compact privilege, you must:

• Hold a current, active license in your home state.
• Have no restrictions or limitations on any state license.
• Have had no disciplinary action taken against any license or compact privilege in the past two years.
• Notify the Compact Commission that you are seeking compact privilege in a specific remote state.
• Pay any required fees.
• Meet any jurisprudence requirements set by the remote state.
• Report any disciplinary action taken against you by a non-compact state within 30 days of that action.

Your compact privilege is valid until your home state license expires. If you practice in a remote state under compact privilege, you must follow that state's laws and rules, not just Indiana's.

If your home state license is restricted or limited in any way, you automatically lose compact privileges in all remote states. You can regain them only after your home state license is fully restored and two years have passed since the disciplinary action that caused the restriction.

Similarly, if a remote state revokes your compact privilege in that state, you lose compact privileges everywhere until the revocation period ends, all fines are paid, and 2 years have passed.

Military and Military Spouses (IC 25-27-2-5)

If you are on active duty in the military or the spouse of someone on active duty, you have flexibility in choosing your home state for compact purposes. You may designate your home of record, your permanent change of station (PCS) location, or your current state of residence (if different from your PCS or home of record). This provision exists specifically to reduce the licensing barriers that military families face due to frequent moves.

Disciplinary Actions Under the Compact (IC 25-27-2-6)

Your home state has the exclusive authority to take disciplinary action against your home state license. However, it can use investigative findings from a remote state to inform that action, as long as it follows its own procedures.

Remote states can take disciplinary action against your compact privilege, meaning they can remove your ability to practice there, issue fines, or take other protective measures. They can also issue subpoenas and, if state law allows, bill you for the costs of investigating a disciplinary case.

Member states may also conduct joint investigations when a licensee's conduct is a concern across multiple states, and they are required to share relevant investigative information with one another.

The Compact Commission (IC 25-27-2-7)

Each member state sends one delegate to the Physical Therapy Compact Commission. That delegate must be a current board member, either a PT, PTA, public member, or board administrator. Each delegate gets one vote on Commission matters.

The Commission meets at least annually and handles tasks such as setting its own bylaws, promulgating rules, managing its budget, and maintaining the data system. It also elects an Executive Board of nine members, of which seven are elected from the Commission membership, one is a representative from the FSBPT, and one is a representative from the APTA (both non-voting). The Executive Board acts on behalf of the Commission between full meetings.

The Compact Data System (IC 25-27-2-8)

The Commission maintains a shared database with licensure, adverse action, and investigation information for every licensed practitioner across all member states. If disciplinary action is taken against a licensee in any member state, all other member states are notified. This shared transparency is one of the compact's most important public protection features; it prevents practitioners from quietly moving to a new state to avoid the consequences of misconduct.

Indiana Code Article 0.5 — Applicability of Certain Provisions in IC 25-1

Why Article 0.5 Matters

Indiana Code Article 0.5 (IC 25-0.5) is a short but important piece of the legal puzzle. Rather than restating general professional licensing rules within every profession-specific statute, the Indiana legislature used this article to formally declare which provisions of IC 25-1 (General Provisions for Professions and Occupations) apply to which regulated professions---including physical therapy (IC 25-27).

Think of Title 25 as an umbrella covering more than 40 licensed professions in Indiana, including medicine, dentistry, nursing, pharmacy, physical therapy, and more. Article 0.5 clarifies that the general rules found in Article 1 apply to all of these professions, including physical therapy, unless a more specific rule in Article 27 addresses the same issue.

The practical takeaway is this: as a physical therapist or physical therapist assistant, you are subject to both the specific rules written just for your profession (Article 27) and the general rules that apply to all Indiana-licensed professionals (Article 1). When the two overlap, the more specific rule typically governs, but you must know both. Article 0.5 is the legal bridge that connects them.

It also reinforces a fundamental principle: every licensed profession in Indiana is held to the same basic standards of accountability. Whether you are a dentist, a pharmacist, or a physical therapist, you are expected to be qualified, honest, and responsible to the public. The specific mechanisms may look different from profession to profession, but the underlying obligations are shared.

The provisions below represent the key IC 25-1 sections that govern Indiana PTs and PTAs under IC 25-0.5.

Criminal history background checks (IC 25-1-1.1-4, via IC 25-0.5-1-17). Any individual applying for an initial PT or PTA license, certificate, registration, or permit must submit to a state and national criminal history background check at the applicant's own expense. Results are released to the Indiana Professional Licensing Agency. The board may also conduct random audits and require a background check at renewal, again at the individual's cost.

License renewal (IC 25-1-2-2.1 and IC 25-1-2-6, via IC 25-0.5-2-14). PT and PTA licenses are issued for a minimum period of two years. Licensees must receive a renewal notice at least 90 days before license expiration. If that notice is not sent, you cannot be penalized for a late renewal, provided you renew within 45 days of receiving any subsequent notice. Upon expiration, you must receive notice of expiration within 30 days of the expiration date. Indiana law protects licensees from penalties when the board fails to provide proper renewal notice; however, it is your professional responsibility to track your own expiration date regardless.

IPLA administrative functions (IC 25-1-5-3 and IC 25-1-5-10, via IC 25-0.5-5-14). The Indiana Professional Licensing Agency performs all administrative functions assigned to the Indiana Board of Physical Therapy. Critically, the IPLA has no policymaking authority---that authority remains exclusively with the board. The IPLA also creates and maintains a public provider profile for every PT and PTA, which includes name, license number and type, issue and expiration dates, current status, city and state of record, and any disciplinary action taken within the previous ten years. This profile is publicly available on the internet. Your disciplinary history, if any, is a public record for at least a decade.

Regulated occupation status and complaint investigation (IC 25-1-7, via IC 25-0.5-8-31). PT, PTA, and any other occupation licensed by the Indiana Board of Physical Therapy is formally designated a "regulated occupation" under Indiana law. This designation activates the full complaint, investigation, and disciplinary framework of IC 25-1-7, administered through the Office of the Attorney General's Division of Consumer Protection. The complaint process works as follows: a written, signed complaint is filed with the Director of the Division of Consumer Protection; the Director makes an initial merit determination, and meritorious complaints are forwarded to the board; the board has 30 days---extendable by up to 20 additional days---to attempt resolution through negotiation; if unresolved, the Director may investigate and report to the Attorney General, who may prosecute before the board on behalf of the State of Indiana. Complaints and related information are strictly confidential until the Attorney General files notice of intent to prosecute. If a person practices PT without a license, the board may file a complaint with the Attorney General, who may seek a cease-and-desist order. Violation of such an order constitutes contempt of court.

Reinstatement of lapsed licenses (IC 25-1-8-6). This provision does not apply to revoked or suspended licenses. If your license has lapsed for three years or fewer, reinstatement requires a completed renewal application, the current renewal fee, an IPLA reinstatement fee, and a sworn CE compliance statement or completion of any required CE remediation. If your license has lapsed for more than three years, reinstatement requires all of the above plus a reinstatement fee equal to the current initial application fee, board-determined remediation and additional training appropriate to the length of the lapse, and any other non-fee requirements established by statute or rule. Letting your license lapse for more than three years significantly increases the cost and burden of reinstatement, and the board has broad discretion to require retraining.

Indiana Code Title 25, Article 1 — General Rules That Apply to All Licensed Professionals in Indiana

Overview

Title 25, Article 1 contains the general rules that apply across Indiana's licensed professions, including physical therapy. These provisions cover a broad range of topics, including your licensing agency, criminal history, continuing education, disciplinary standards, and more. Because these rules sit underneath and support everything else we have covered, every PT and PTA needs to understand them.

Personal Property Taxes (IC 25-1-1)

This one is straightforward: you cannot receive an Indiana professional license if you have unpaid personal property taxes. Applicants who own taxable assets must present documentation from their county treasurer confirming taxes have been fully paid. Applicants who own no taxable assets must provide a statement from the county assessor confirming no taxes are owed. Clear any outstanding personal property tax obligations before submitting a license application.

Criminal Convictions and Licensure (IC 25-1-1.1)

Indiana takes a measured and fair approach to the relationship between criminal history and professional licensing. The general principle is that a license cannot be denied, taken away, or suspended solely because of a criminal conviction. However, the conduct behind the conviction can be considered when evaluating whether someone can be trusted to serve patients safely.

A "conviction of concern" is one that is closely related to the specific duties and responsibilities of your profession, as determined by the board. For example, a conviction for healthcare fraud would be far more directly relevant to physical therapy practice than a conviction for a minor traffic offense.

Regardless of the nature of a conviction, if you are licensed in Indiana and you are convicted of any misdemeanor or felony, except for routine traffic violations that do not involve impaired driving, you must notify the board in writing within 90 days. Your notification must include a certified copy of the court order or judgment, along with a letter explaining the circumstances.

When the board can suspend or revoke a license based on a conviction (IC 25-1-1.1-2). The board has the authority---but not always the obligation---to suspend, deny, or revoke a license if you have been convicted of certain offenses and the board determines, after meeting with you in person, that the conviction affects your ability to practice safely. This discretionary authority applies to convictions including possession of cocaine, narcotic drugs, methamphetamine, or other controlled substances; fraudulent activity related to controlled substances; drug paraphernalia offenses classified as a Class D or Level 6 felony; felony-level possession of marijuana, hash oil, hashish, salvia, synthetic drugs, or related substances; maintaining a location where controlled substances are illegally used or distributed; violations related to drug registration, labeling, or prescription forms; sex crimes as defined under Indiana law; and any other felony offense that negatively affects your fitness to practice.

When the board must revoke or suspend a license (IC 25-1-1.1-3). Some convictions leave the board with no choice — revoking or suspending your license. These are the most serious drug-related offenses, including dealing in controlled substances (cocaine, narcotic drugs, methamphetamine, marijuana as a felony, and scheduled substances of any class); manufacturing methamphetamine; knowingly manufacturing, distributing, or possessing with intent to distribute falsely represented controlled substances; and violations of federal or state drug laws related to wholesale legend drug distributors. If you are convicted of any of these offenses, the board does not need to evaluate whether the conviction affects your ability to practice; revocation or suspension is mandatory. A criminal conviction does not automatically end your career, but certain drug-related and felony convictions can, and some require mandatory license action regardless of circumstances.

Criminal background checks (IC 25-1-1.1-4). All new license applicants must undergo a national criminal history background check through the FBI using fingerprinting or another reliable identification method. The cost of this check is the applicant's responsibility. The board may also randomly audit practitioners renewing their licenses and require them to undergo a background check, again at their own expense.

How your personal information is used (IC 25-1-1.1-5). There is a formal data-sharing agreement between the Indiana State Police and the Indiana Professional Licensing Agency that governs how your personal information (your name, address, Social Security number, driver's license number, photograph, phone number, and fingerprints) is used. That information can only be used for official government purposes related to licensure and law enforcement, and it must remain confidential. Only authorized agencies, such as courts, law enforcement, prosecuting attorneys, the licensing agency, and the Attorney General's office, may access it.

Fairness in using your criminal history (IC 25-1-1.1-6). Indiana law is specific about how criminal history can and cannot be considered in licensing decisions. Licensing boards cannot use vague, subjective terms such as "good moral character" or "moral turpitude" as grounds for denying a license. An arrest without a conviction cannot be used against you. A conviction can only be used to deny a license if it is directly related to the duties of the profession. In most cases, a conviction cannot be used to disqualify you for more than five years from the date of the conviction unless the offense was a violent crime, a criminal sexual act, or you committed another offense during the disqualification period.

If you have a criminal record and want to know whether it would prevent you from getting licensed, you can petition the board at any time to find out. You will need to submit an FBI background check at your own expense, along with any other information the board requests. When reviewing your criminal history, the board must consider how serious the offense was, how much time has passed, whether the conviction actually affects your ability to practice, and any evidence of rehabilitation. If a license is denied because of a criminal conviction, you must receive a written explanation that includes the reason for the denial, your right to appeal, the earliest date you can reapply, and the board's recognition of any rehabilitation you have completed. The board bears the burden of proving that the denial is justified, and that proof must meet a "clear and convincing" standard. The board must respond to your petition within 60 days of receiving all required documentation, and may charge a processing fee of up to $25.

License Suspension for Court Orders (IC 25-1-1.2-7 and IC 25-1-1.2-8)

If the board receives a court order related to certain family law matters, it must suspend your license or deny your application. A notice is mailed to your last known address, and the suspension takes effect five business days after that notice is sent. The suspension is lifted ten business days after the board receives a court order authorizing reinstatement.

Similarly, if the board receives notice from the Bureau of Child Support that you have overdue child support, your license goes on probationary status. You will receive a notice explaining the amount owed and the steps to resolve the issue, including the amount in arrears and how to pay in full or establish a payment plan. If the board does not receive confirmation that the issue is resolved within 20 days, your license will be suspended. The board cannot lift the suspension until it receives official confirmation from the bureau that the delinquency has been addressed. Child support delinquency is treated as a licensing matter in Indiana — a court order can trigger probation and, within 20 days, suspension, independent of any professional conduct concerns.

Continuing Education (IC 25-1-4)

"Continuing education" is defined as an orderly process of instruction approved by the board or an approved organization, and designed to directly enhance the practitioner's knowledge and skills in services relevant to their profession.

When you renew your license, you must swear that you have completed your required continuing education. You must keep your completion certificates and records for three years after the end of the renewal period in which those hours were applied. The licensing agency may audit between 1% and 10% of practitioners each renewal cycle, so be prepared to provide documentation if asked. A sworn statement at renewal is legally binding, and falsifying it carries serious financial and licensure consequences.

At least one-half of all CE requirements must be allowable by distance learning methods. If you are called to active military duty, you are permitted to fulfill all continuing education requirements through distance learning.

The board may also grant a partial or full waiver of continuing education requirements if you experienced a hardship during the renewal period, specifically if you served in the armed forces for a substantial portion of that period, experienced an incapacitating illness or injury, or encountered other circumstances the board deems sufficient.

What happens if you do not complete your CE on time? The board will send a certified mail notice of noncompliance to your last known address. You then have 21 days to respond.

Your two options are:

1. You believe you are in compliance. Submit written proof to the board and request a review.
2. You accept the finding. You must pay a civil penalty of up to $1,000 within 21 days, complete any outstanding CE credits within six months, and meet all other applicable requirements.

If you do not respond or do not follow through on the corrective actions, the board will immediately suspend your license or deny your reinstatement, and you will be notified by certified mail.

If you knowingly or intentionally lie about your CE compliance, you could face an additional civil penalty of up to $5,000.

If this is your second consecutive renewal period with a noncompliance notice, the board will deny your renewal application outright. Getting back in good standing will require paying a civil penalty, completing all required CE hours, and fully meeting all other renewal requirements. Hours completed to satisfy a prior noncompliance finding do not count toward the CE requirement for the new period.

The Indiana Professional Licensing Agency (IC 25-1-5)

The Indiana Professional Licensing Agency (IPLA) is the administrative hub for professional licensing in Indiana. It handles the behind-the-scenes work that makes the licensing system run for all licensed professions, including physical therapy. Its responsibilities include organizing board meetings, maintaining license records, administering exams, processing license renewals, and running the electronic registry of all licensed professionals in Indiana. Critically, the IPLA has no policymaking authority---that authority remains exclusively with the board.

The PLA is your one-stop shop for license-related tasks: renewing your license, verifying licenses, updating your address, tracking your application, ordering or printing your license, filing a complaint, and viewing disciplinary action records. You can access all of this at https://www.in.gov/pla/.

Some important PLA timelines to know:

• The agency must notify you of your upcoming renewal at least 90 days before your license expires. If they fail to do so, you will not be penalized for a late renewal as long as you complete it within 45 days of receiving the notice.
• The agency must process renewal applications within 10 business days of receiving all required materials, or within 24 hours if you appear in person.
• If there is a concern that you may have committed a violation, the agency can delay your renewal for up to 120 days to allow for investigation. During this time, your license remains valid. If the board takes no action within 120 days, your license is automatically renewed.
• Applications that are started but not completed are considered abandoned after one year. The board may grant 30-day extensions for good cause.

Electronic applications are now required. As of January 1, 2024, all applications for new licenses and renewals must be submitted electronically. If you prefer a paper application, you may request one from the agency. Each February, the agency must publish data from the previous year on the number of licenses issued, the time required for processing, and the number of renewals completed.

Military Service — License Extensions and Fee Waivers (IC 25-1-12-6 and IC 25-1-12-7)

Indiana law provides meaningful protections for practitioners on active military duty.

Extension of time to renew and complete CE (IC 25-1-12-6). A practitioner called to active duty out of state is entitled to an automatic 180-day extension after discharge or release to renew their license and complete any required continuing education, provided all of the following are true at the time active duty begins: the license is not revoked, suspended, lapsed, or subject to a pending complaint; the license expires while the practitioner is out of state on active duty; and the practitioner had not yet received a renewal notice before entering active duty. To claim the extension, the practitioner must provide a copy of their discharge paperwork or government movement orders to the board at the time of renewal. If an illness, injury, or disability related to active duty prevents timely renewal even within the 180-day window, the board may grant an additional extension---but not beyond 365 days from the date of discharge.

Waiver of late fees (IC 25-1-12-7). Any late fees that would otherwise be assessed against a practitioner renewing under the military extension provisions are fully waived. If your license lapses while you are deployed out of state, you have up to 180 days after discharge to renew without penalty---and potentially up to a full year if service-related health issues are involved.

Temporary Practice Exemption for Athletic Organization Practitioners (IC 25-1-15)

A separate statute, IC 25-1-15, provides an additional exemption that applies specifically to practitioners — including physical therapists — who are traveling to Indiana with a visiting athletic or sports organization for a specific sporting event. While IC 25-27-1-3.3 above broadly addresses athletic team travel and allows up to 60 days, this provision establishes a stricter, event-specific framework and applies to practitioners licensed in any other U.S. state, territory, or jurisdiction, as well as to practitioners licensed in foreign jurisdictions.

To qualify for this exemption, all three of the following conditions must be met: the practitioner holds an active license in their home jurisdiction; the practitioner is actively practicing in that profession in their home jurisdiction; and the practitioner is employed or officially designated as the practitioner for an athletic or sports organization that is visiting Indiana for a specific sporting event.

This exemption comes with important limitations that distinguish it from the broader IC 25-27-1-3.3 athletic team exemption. Practice is strictly limited to the members, coaches, and staff of the visiting athletic or sports organization — not the general public. The exemption may not exceed 30 consecutive days for a specific event.

In practical terms: if you travel to Indiana as the designated PT for a visiting team or organization, you may practice without an Indiana license, but only for that team, only for that specific event, and only for up to 30 consecutive days. If your work extends beyond that window or involves treating anyone outside the organization, you will need an Indiana license. For more information on these two statutes, I recommend contacting the Indiana Professional Licensing Agency and/or the Indiana Physical Therapy Board.  

Professional Conduct and Disciplinary Standards (IC 25-1-9-4)

Your license comes with legal obligations about how you conduct yourself in practice. If the board determines, after a formal hearing, that you have violated professional standards, it can impose disciplinary sanctions.

The following behaviors can lead to disciplinary action:

• Dishonesty. This includes committing fraud to obtain a license (such as cheating on an exam), committing fraud in your professional practice, advertising your services falsely, or being convicted of fraudulent billing involving Medicare, Medicaid, the Children's Health Insurance Program, or insurance.
• Criminal convictions that affect your ability to practice competently or pose a risk to public safety.
• Violating state or federal laws that apply to your profession.
• Being unfit to practice. This covers practicing beyond your training or experience, failing to stay current in professional knowledge, having a physical or mental disability that impairs your practice, or struggling with addiction to alcohol or drugs in a way that puts patients at risk.
• Unethical conduct. This includes lewd or immoral behavior while providing services, allowing someone else to use your license or name to provide services they are not qualified to provide, or having disciplinary action taken against you in another state for similar reasons. Out-of-state discipline follows you to Indiana---a certified record of that action is treated as solid evidence that can be used to support similar action here.
• Drug-related violations. This includes diverting prescription drugs for unauthorized use, or illegally prescribing or administering narcotics to a known addict.
• Not complying with a disciplinary order that was previously imposed.
• Sexual misconduct. This includes making sexual advances, requesting sexual favors, or engaging in any sexual contact or communication with patients, clients, or coworkers. Providing care to your own spouse is not a violation under this section.
• Collecting unauthorized fees from patients enrolled in a health maintenance organization (HMO).
• Helping someone else commit a violation that would itself result in disciplinary action.
• Failing to report suspected child abuse to the Department of Child Services or law enforcement as required by Indiana law.
• Disciplinary grounds extend well beyond clinical incompetence. Billing fraud, boundary violations, credential misuse, failure to report child abuse, and failure to address human trafficking indicators are all actionable.

Human Trafficking Awareness (IC 25-1-9-4.5)

Physical therapists and physical therapist assistants work in environments such as clinics, hospitals, schools, and homes where they may encounter patients who are victims of human trafficking. Indiana law requires that if you observe signs that a patient may be a trafficking victim, and a similarly trained clinician would reasonably reach the same conclusion, you must provide that patient with information about available services and resources, including the National Human Trafficking Hotline: call or text 1-888-373-7888, or text "HELP" to 233733.

Failing to do so when the evidence warrants it can result in disciplinary action by the board. This is not just a legal obligation; it is an opportunity to meaningfully intervene in someone's life when they may have no other advocate.

Indiana Administrative Code — Title 842, Article 1: Physical Therapists and Physical Therapist Assistants

What Is the Administrative Code and Why Does It Matter?

If the Practice Act is the big-picture law, the Indiana Administrative Code (IAC) is the operational manual. It provides the specific, detailed rules that tell you exactly how to handle daily practice situations, such as how often a PT must see a patient being treated by a PTA, what counts as continuing education, how to advertise your services ethically, and what you must do when leaving a practice.

Title 842 of the IAC was written by the Indiana Board of Physical Therapy. Knowing the administrative code is not optional. All Indiana-licensed PTs and PTAs are held accountable to it, and "I didn't know the rule" is not an acceptable response before the board.

Additional Definitions in the Administrative Code (842 IAC 1-1-1 and 1-6-1)

The administrative code includes definitions that either add to or clarify provisions already in the Practice Act.

Bureau refers to the Health Professions Bureau.

Committee refers to the Indiana Physical Therapy Committee.

Contact hour is the unit of measurement for continuing competency activities. One contact hour equals at least 50 minutes of active participation in a learning activity.

Direct supervision, as defined specifically in the administrative code, means that the supervising PT or physician is always available and always responsible for the person they are supervising. For temporary permit holders, if the supervising PT or physician is not continuously on-site, the permit holder must meet face-to-face with that supervisor at least once per working day to review all patients' care. All patient records written by the permit holder must be countersigned by the supervising PT or physician.

For PTA supervision specifically, unless the supervising PT or physician is physically present the entire time, the PTA must consult with the supervising PT or physician at least once per working day to review patient care. That consultation can happen in person, by phone, or via a communication device for the hearing-impaired, as long as it involves real, two-way communication about patient care.

The supervising PT or physician must personally examine each patient at a minimum:

• Every 14 days for patients admitted to a hospital or comprehensive rehabilitation facility.
• The earlier of every 90 days or every 6 PT visits for patients in facilities for individuals with intellectual or developmental disabilities, and for school system patients.
• The earlier of every 30 days or every 15 PT visits for all other patients.

If daily consultations between the supervising PT and the PTA are not conducted face-to-face, the supervising PT or physician may not oversee more than the equivalent of 3 full-time PTAs at any given time.

Professional incompetence is defined in the code as a pattern of repeated behavior that shows a failure to exercise the level of care and diligence that a similarly situated practitioner, in the same or similar type of practice setting and location, would reasonably exercise. A single mistake may not rise to this level---but a pattern of poor judgment or substandard care can.

License Renewal (842 IAC 1-4-1)

Every licensed PT and certified PTA must renew by July 1 of each even-numbered year. This is your responsibility, period. If you change your address and the renewal notice never reaches you, that does not excuse a late renewal. You are expected to keep your contact information current and to know when your renewal is due.

Keeping Your Contact Information Current (842 IAC 1-4-2)

If your name, address, or phone number changes, you must notify the Indiana Board of Physical Therapy in writing within 30 days of that change. 

Continuing Competency Requirements (842 IAC 1-7-1 and 1-7-3)

Every PT and PTA in Indiana must complete 22 hours of continuing competency activities during each two-year renewal period. Here is how those hours must be distributed:

• At least 10 hours must be Category I activities, and exactly 2 hours must be in an ethics and Indiana jurisprudence course related to physical therapy practice. (This course counts!)
• No more than 10 hours may be Category II activities.

Hours cannot be carried over from one renewal period to the next. If your license has been active for less than 12 months, no continuing education is required for that cycle. If it has been active for 12 to 23 months, you need 12 hours total, including the 2-hour ethics and jurisprudence course.

Your Responsibilities as a Licensee (842 IAC 1-7-2)

When you renew your license, you must certify that you have completed your required continuing competency hours. You must also keep your completion certificates and documentation for three years after the last renewal date, and be able to provide proof of your CE completion to the board in a verifiable format if audited. Do not throw away your certificates when a new renewal period begins. Hold onto them for three years after the close of each period.

Category I and Category II Continuing Competency Activities Explained (842 IAC 1-7-4)

Category I is the more formal of the two categories. These are structured, professionally organized learning activities that must be at least one contact hour in length and relevant to physical therapy practice. They include live or recorded courses, workshops, seminars, and symposia; home study programs, including board-approved computer, audio, or video programs; and approved college credit courses related to physical therapy.

Academic credit conversions for Category I: one semester credit hour equals 15 contact hours; one quarter credit hour equals 10 contact hours; one trimester credit hour equals 12.5 contact hours.

Category II includes a wider variety of activities that reflect professional engagement beyond formal coursework. These count up to the 10-hour maximum per renewal period and include:

• Writing and publishing. Publishing scientific papers, abstracts, or review articles in professional journals; publishing textbook chapters; presenting posters or papers at professional conferences. Credit: 10 hours per refereed (peer-reviewed) article; 3 hours per nonrefereed article, published abstract, or book review; 8 hours per published textbook chapter; 5 hours per poster or platform presentation or review article. Maximum: 10 hours per renewal period.
• Teaching at an accredited PT or PTA program as an adjunct instructor. Two CE hours for each academic credit hour the course is worth, for the first time you teach it. Maximum: 10 hours per renewal period.
• Presenting at approved CE courses, seminars, or workshops. Two contact hours for each hour of your presentation, for your first presentation event. Maximum: 10 hours per renewal period.
• Supervising PT or PTA students in full-time clinical internships or residency programs. One contact hour per 40 hours of supervision. Maximum: 10 contact hours per renewal period.
• In-service or in-house seminars related to physical therapy practice. One credit hour per hour of in-service. Maximum: 4 hours per renewal period. Documentation must include the topic, date, duration, and presenter's name.
• Serving in a leadership role in a professional organization related to physical therapy. One credit hour for every six months of active service as an officer, delegate, or committee member. Maximum: 6 hours per renewal period.
• Earning or renewing a specialty certification through the American Board of Physical Therapy Specialties (ABPTS) or another board-approved organization. Maximum: 10 hours per renewal period, awarded only in the year the certification is obtained or renewed.
• Earning or renewing a PTA Certificate of Advanced Proficiency through the APTA. Maximum: 5 hours per renewal period, in the year obtained or renewed.
• Attending INAPTA state or district meetings that are at least one hour long. One credit hour per meeting. Maximum: 4 hours per renewal period.
• Other educational or scholarly activities not listed above, with prior approval from the committee.

Standards of Professional Conduct (844 IAC 6-7-2)

These standards define what it means to practice as a physical therapist or physical therapist assistant with integrity. All practitioners licensed in Indiana are responsible for knowing and following them.

Fees and Financial Arrangements

Your fees must be reasonable. They should reflect the actual services you provided, not what would be most profitable or what you think you can get away with charging. Factors that go into determining reasonable fees include: the difficulty and uniqueness of what you did; the time, skill, and experience required; what other practitioners in your area charge for similar services; and the quality of what you delivered.

You may not pay or receive a kickback for referring patients. The only exception is a formal patient referral program operated by a professional society or association. You also may not make your fee contingent on the outcome of a lawsuit or any other uncertain future event.

Advertising

You are permitted to advertise your physical therapy services through public media---print, digital, radio, TV, and similar channels---as long as your advertising is professional and sticks to accurate information about what physical therapy is and what you do. If you advertise on radio, cable, or television, those ads must be prerecorded and approved by you before they air, and you must retain a recording and transcript of the actual broadcast for five years from the last date it ran. You cannot use advertising that contains anything false, misleading, deceptive, or unfair.

Patient Care

Taking care of patients ethically means more than good clinical technique. It also means:

• Keeping information confidential. What you learn about your patients in the course of their care, including their diagnosis, treatment, prognosis, and any personal details, stays between you and those involved in their care. You do not share it without legal obligation or the patient's written consent.
• Being honest with patients about their condition. Give them a truthful and reasonably complete account of what is going on with their health unless sharing that information could genuinely harm their physical or mental well-being.
• Never abandoning a patient. If you need to withdraw from a case for any reason, you must give reasonable written notice to both the patient and the referring provider so they have time to find another provider. Do not leave a patient without a care plan. Unless it is an emergency, you must comply with a patient's written request for their health records when you withdraw from their care.
• Practicing within your competence. Base your care on generally accepted scientific principles, current professional knowledge, and established methods and treatments.
• Maintaining adequate records. Documentation is not optional; it is a core professional and legal responsibility.

Conduct That Will Lead to Disciplinary Action

As a licensed practitioner, the following behaviors are prohibited and can result in serious consequences, including suspension or revocation of your license:

• Engaging in sexual misconduct of any kind with patients, clients, or coworkers.  This includes verbal, physical, or any other form.
• Providing substandard care due to negligence or a deliberate failure to act, whether or not the patient was actually harmed.
• Practicing while your physical or mental abilities are impaired by alcohol, controlled substances, habit-forming drugs, or other chemicals.
• Trying to prevent a patient or colleague from filing a complaint against you.
• Trying to limit your own liability for malpractice through anything other than an informed, voluntary settlement with a patient.
• Holding a felony conviction (or a plea of no contest or other finding of guilt for a felony) in any state or country if that conviction reflects impaired judgment or risk to patients.
• Interfering with a board investigation through misrepresentation, threats, or harassment of patients or witnesses.
• Helping anyone in Indiana who is not licensed or certified to perform activities that require a license or certificate.

When You Are Leaving a Practice

If you are retiring, stopping practice, or leaving the area, Indiana law has specific rules about how you must handle your patients and their records:

• You may not sell patient records to another practitioner for anything of value.
• You must notify all active patients in writing, or by publishing a notice in a local newspaper once a week for three consecutive weeks, that you are discontinuing your practice. You must also notify the referring provider for each active patient.
• You must make reasonable arrangements for transferring records to the patient's next provider or to a program run by a professional society or association.

An "active patient" is anyone you have examined, treated, cared for, or consulted with during the two years immediately before you retire, stop practicing, or leave the area.

Dry Needling Ruling: Practice Ruling #2023-12-1 (effective June 30, 2024)

The board issued this ruling in February 2024 to address dry needling and clarify the requirements for PTs who want to offer this service.

Here is what the ruling requires:

• Before performing dry needling on a patient, you must complete a minimum of 50 hours of specialized dry needling education.
• At least 40 of those 50 hours must be in-person training. Online learning alone is not sufficient.
• You must be able to produce documentation of your qualifications upon request from the board.

Here is what the ruling prohibits:

• You cannot delegate dry needling to anyone---not to another PT who has not completed the training, and not to a PTA, even if they would otherwise be working under your direct supervision.
• You cannot allow another PT to perform dry needling under your supervision if that PT has not completed the required 50 hours.

The bottom line: if you have not completed the required 50-hour training program (with at least 40 in-person hours), you cannot perform dry needling, and you cannot allow anyone else to perform it on your behalf.

Summary

What You Need to Remember

Let us close with the key points that matter most in your day-to-day practice.

• Know the law, and keep up with changes. Your license depends on it. Bookmark https://www.in.gov/pla/professions/physical-therapy-home/ and check it periodically for updates to rules, board rulings, and licensing information.
• Renew on time. Your license or certificate expires on June 30 of each even-numbered year. If you miss the deadline, your license automatically becomes invalid.
• Complete your continuing education. Every two-year renewal period, you need 22 hours of continuing competency activities, including at least 10 hours of Category I courses and exactly 2 hours of ethics and Indiana jurisprudence. Keep your certificates for three years after each renewal period.
• Update your contact information. If you move, change your name, or get a new phone number, you must notify the board within 30 days. If your renewal notice goes to an old address, that is on you.
• Report criminal convictions. If you are convicted of a misdemeanor or felony (excluding standard traffic violations), you must notify the board in writing within 90 days, with supporting documentation and an explanation.
• Follow the referral rules. You can treat patients without a referral for up to 42 days, but spinal manipulation always requires a referral from a physician, osteopathic physician, or chiropractor, and that provider must have personally examined the patient first. Sharp debridement also requires a referral from a physician, osteopath, or podiatrist.
• Supervise properly. Understand the differences among direct, general, and onsite supervision, and know which applies in your setting. Follow the patient examination timelines when supervising PTAs. Do not allow aides to perform tasks without direct supervision.
• Dry needling requires specific training. You need 50 hours of specialized education, with at least 40 of those hours in person, before you can perform dry needling. You cannot delegate this service to PTAs or to PTs who have not completed the training.
• Practice ethically. Maintain patient confidentiality. Communicate honestly. Never abandon a patient. Keep good records. Do not let anyone perform services under your name or license that they are not qualified to perform. Cooperate with any board investigation.
• The compact applies to telehealth. Physical therapy practice occurs where the patient is located, not where you are sitting. If your patient is in another state during a telehealth session, you need to be authorized to practice in that state.
• Know your human trafficking obligation. If you observe signs that a patient may be a trafficking victim and a similarly trained clinician would reach the same conclusion, you must provide that patient with information about available resources, including the National Human Trafficking Hotline at 1-888-373-7888.

Thank you for taking the time to complete this course. The laws and rules we have covered today are not just bureaucratic requirements---they reflect the values at the heart of your profession: competence, honesty, respect for patients, and a commitment to doing no harm. Knowing them, following them, and staying current with them is part of what it means to be a professional.  

This course reflects Indiana law as of the date of publication. Laws and administrative rules are subject to change. It is the licensee's responsibility to verify current requirements with the Indiana Board of Physical Therapy and the Indiana Professional Licensing Agency.

Key Resources

• Indiana Professional Licensing Agency: https://www.in.gov/pla/
• Indiana Physical Therapy Board: https://www.in.gov/pla/professions/physical-therapy-home/physical-therapy-board/
• Indiana Code Title 25, Article 27: https://iga.in.gov/laws/2023/ic/titles/25#25-27
• Indiana Administrative Code Title 842: http://iac.iga.in.gov/iac/iac_title?iact=842
• Physical Therapy Compact Commission: https://www.ptcompact.org/
• APTA Scope of Practice: https://www.apta.org/your-practice/scope-of-practice
• National Human Trafficking Hotline: 1-888-373-7888