COLORADO STATE BOARD OF CHIROPRACTIC EXAMINERS
Final Amendments and New Rules

The Board of Chiropractic Examiners proposes the following amendments to the existing rules pursuant to their rulemaking authority in 12-33-107(1)(a), C.R.S.

Rule 10 Continuing Education 
A.   The Board will accept continuing education that falls within these regulations and 
       relies upon each individual chiropractor’s integrity in complying with this  
       requirement. 

B.   Continuing chiropractic education program sponsors need not apply for nor expect to 
       receive prior Board approval for a formal continuing chiropractic education program.  
       The number of credit hours may be determined by counting the credit hours of
       instruction and rounding to the nearest quarter hour. The Board relies upon the
       integrity of the program sponsors to present continuing chiropractic education that
       constitutes a meritorious learning experience and complies with §12-33-116 and 
       12-33-111, C.R.S. If the Board discovers that a sponsor has falsified information 
       regarding the course, the sponsor may be required to have all future courses pre-
       approved. 

C.   Each licensed Colorado chiropractor in active practice within the state of Colorado is 
       required annually to attend not less than fifteen hours of scientific clinics, forums, or 
       chiropractic educational study consisting of subjects basic to the field of the healing 
       arts as set forth in §12-33-111, C.R.S. "Annually" is defined as the twelve month 
       period between August 1 and July 31. Each renewal period contains two years (24 
       months). Each licensed Colorado chiropractor is required to maintain “Health 
       Provider Level Cardiopulmonary Resuscitation” as is necessary to keep current and 
       maintain valid certification, as provided by the American Heart Association or other 
       organizations deemed equivalent by the Board.  All current licensees    
       must maintain proof of such certification. The hours necessary to  
       maintain this cardiopulmonary resuscitation certification may be used towards the   
       continuing education hours required. 

D. Annual Requirements 

1. The continuing education requirement is waived for the first renewal period if the licensee has been licensed less than six months. In addition, licenses granted July 1 or later of the even year in the renewal period will be responsible for only 15 hours of continuing education in their first renewal period. If the first Colorado license issued expires 6 to 12 months from the date of its issuance, 15 hours of continuing education are required. If the first Colorado license issued expires more than 12 months from the date of its issuance, 15 hours of continuing education are required for each year. 

2. Current Cardiopulmonary Resuscitation (CPR) certification is required for all licensees. All current licensees must maintain proof of such certification. 
1.   The continuing education (CE) requirements for the  
licensee’s first renewal period is as follows:

	a.   Licensed less than twelve months – no CE required to 
renew license.

	b.   Licensed twelve to twenty-four months – fifteen hours  
of CE must be completed.

2.   Two of the fifteen hours of the annual continuing 
education requirements shall AT A MInIMUM be in recordkeeping and documentation.

E.  Course content is limited to scientific subject matter basic to the field of the healing 
      arts and includes, but is not limited to: Anatomy, embryology, histology, physiology,
      psychology, biochemistry, pathology, bacteriology, toxicology, pharmacology, public 
      health, hygiene, sanitation, first aid, diagnosis (including but not limited to physical, 
      laboratory and all other recognized diagnostic procedures), x-rays, obstetrics and 
      gynecology, and principles and practice of chiropractic including but not limited to 
      professional boundary issues, ethics, and adjustive technique.

F.  Offerings in the promotion of practice building or office management shall not be 
      approved for continuing education. 

G. Offerings dealing with practices designated as untrue, misleading, and deceptive 
     pursuant to Rule 8 and offerings dealing with practices outside the chiropractic scope 
     of practice shall not be approved for continuing education. 

H. Instructors must be qualified, as determined by the Board, to teach the course 
     outlined. 

I. Up to ten (10) hours per year of continuing education credit may be obtained by 
   distance learning including, but not limited to, video and audio tapes or internet 
   education programs. To obtain continuing education credit for distance learning, 
   successful completion of a proficiency testing component is required. 

J. The Board will MAY conduct a random compliance audit of renewal applicants to 
    verify course content, instructor qualifications, and number of hours completed. If the 
    Board determines that the applicant has not obtained continuing education that falls 
    within the subject matter defined in §12-33-111, C.R.S. or the applicant fails to submit 
    proof of continuing education satisfactory to the Board, the Board may consider 
    disciplinary action for failure to comply with §12-33-116, C.R.S. 

K. The licensee must maintain in his/her own file, the dates of the program, certificate of attendance that includes hours in attendance, synopsis of the course content, identity of the course sponsor, and the qualifications of the instructor. 

Rule 22 Record Keeping Requirements
 A. Records of an initial consultation shall include but are not limited to: history relevant 
      to the current complaint, past medical history, social and family history. 

B. Records of any examination that is more comprehensive than a brief examination 
    shall include but are not limited to: findings of all examination procedures performed, 
    x-rays when chiropractically necessary, a working diagnosis, a treatment plan, and a 
    prognosis. 

C. Once a treatment plan is established, patient records shall include but are not limited 
     to: patient complaints or symptomatology, the chiropractor's findings, assessment, 
     and treatment provided for each visit. Periodic reassessment as indicated should also 
     be recorded. SOAP format is acceptable. Re-evaluation of treatment plans must be 
     specifically documented. 

D. Records are required to be legible and utilize standard medical terminology and 
     abbreviations. 

E. Patient records shall be retained for a minimum of seven years after the last date of 
     treatment or examination, or at least two years after the patient reaches the age of 
     eighteen, whichever occurs later. 

F. When the destruction cycle is imminent, written notice to the patient’s last known 
     address, or notice by publication, must be made sixty (60) days prior to destruction 
     allowing a thirty (30) day period wherein the patient may claim his/her records. When 
     a patient claims such records, the records must be provided to the patient, or legal 
     guardian, at no charge; however, recovery of appropriate postage and handling costs 
     is permitted. 

G. Records may not be withheld for past due fees. 

H. Records shall be destroyed in a manner that totally obliterates all information contained in the record such as by incinerating or shredding.

Documentation of the patient’s health history, presenting complaint(s), progression of care, diagnosis, prognosis and treatment plan must be reflected in the record keeping and written reports of the patient file.  Records are required to be contemporaneous, legible, utilize standard medical terminology or abbreviations, contain adequate identification of the patient, contain adequate identification of the provider of service and indicate the date the service was performed.  All professional services rendered during each patient encounter should be documented.  Any addition or correction to the patient file after the final form shall be signed and dated by the person making the addition or correction.  The following minimum components must be documented within the patient file:
A.	Initial Patient Visit:
1.	History:
a.	Chief complaint(s) described in terms of onset, provocative, palliative, quality, radiation, setting, and timing.
b.	Surgical, hospitalization, past/recent illness, trauma, family, social, past/recent system review, and past/recent allergies.
c.	Non-prescription, prescription, botanical, homeopathic medicines, and vitamin supplements.
d.	review of pertinent records from other health care providers, imaging, and facilities as indicated.
d.	A reasonable effort should be made to obtain and review pertinent records as clinically indicated from other health care providers, imaging facilities, or laboratories.
2.	Examination:
a.	Vital signs as clinically indicated.
b.	Document examinations or tests ordered or performed and the results of each as necessitated by the patient’s clinical presentation consistent with common healthcare practices.
c.	Document examinations of neuromusculoskeletal conditions using a format of inspection, palpation, neurological testing, range of motion, and orthopedic testing.
d.	Document prognosis and/or outcome expectations.
e.	When appropriate When clinically indicated, treatment options/alternatives should be documented.
f.	When referring to another healthcare provider, correspondence may SHALL be provided for patient care coordination AS APPROPRIATE.
B.	Established Patient Visit:
1.	Subjective Complaint:  The patient’s description of complaints should be recorded at each visit indicating improvement, worsening, or no change.
2.	Objective Findings: Changes in the clinical signs of a condition should be described by the doctor chiropractor at each visit.
3.	Assessment or Diagnosis:  It is not necessary to update this category at each visit.  However, periodic clinical re-evaluations should be performed, specifically documented and recorded in the daily entries.  Changes in the patient’s diagnosis should be recorded in the daily entries when clinically indicated.  Prognosis and/or outcome expectations should be updated periodically consistent with the clinical presentation.
4.	Plan of Management:  A provisional plan of management should be recorded initially and further entries should be made as this plan is modified and/or as a patient enters a new phase of treatment or has a diagnosis change.  Changes in procedures should be documented and based on clinical assessment and reasoning.
5.	Procedures:  Daily recording of procedures performed should include a description of type and location of procedure.  Units of time should be recorded when appropriate. 
C.	Ancillary Documentation:
1.	Correspondence sent and received.
2.	Specialty reports (diagnostic imaging, laboratory results, nerve conduction studies, etc.).
3.	Communications (telephone conversations, dialogue with patient, guardian or other healthcare providers). 
D.	Patient clinical records shall be retained maintained for a minimum of seven (7) years after the last date of treatment or examination, or at least two years after the patient reaches the age of eighteen, whichever occurs later.  If patient records are maintained electronically, then a back-up and data recovery system must be in place.
E.	When the destruction cycle is imminent, written notice to the patient’s last known address, or notice by publication, must be made sixty (60) days prior to destruction allowing a thirty (30) day period wherein the patient may claim his/her records.  When a patient claims such records, the records must be provided to the patient, or legal guardian, at no charge; however, recovery of appropriate postage and handling costs is permitted.
F.	Records shall be destroyed in a manner that totally obliterates all information contained in the record such as by incinerating or shredding.
G.	Records may not be withheld for outstanding/past due professional fees.  A reasonable fee for copying records may be assessed to the requesting party.
H.	Documentation of Treatment:
1.	It is the responsibility of the doctor of chiropractic to maintain a patient health care record that includes periodic measures of treatment response.  During the acute, subacute, and chronic phases of treatment, re-evaluations or objective measures of treatment response is recommended at intervals as clinically indicated.
2.	Maximum therapeutic benefit should be documented following a course of care, where measured improvement would be expected in a patient’s health status and one or more of the following are present:
a.	The patient has returned to pre-clinical health status.
b.	Measurable improvement has occurred and there is no basis for further treatment.
c.	The patient no longer demonstrates measurable clinical improvement.
d.	Measurable improvement has not been achieved. 
e.	There is insufficient information to validate the response to treatment.
Once maximum therapeutic benefit has been determined, the treating doctor of chiropractic should document either:  1) discharge the patient, 2) refer for additional evaluation/treatment, 3) recommend supportive care, or 4) recommend maintenance care.
3.	Supportive treatment/care is care of patients in whom periodic trials of therapeutic withdrawal have failed to sustain previous therapeutic gains and the care should be documented.
4.	Maintenance treatment/care is a form of elective care in the absence of symptoms and/or objective findings with the goal of “wellness” or “preventative services” in order to maximize general health and well being and the care should be documented.
H.	Routine record-keeping procedures apply to all individuals to whom chiropractic services are rendered regardless of location.