DEPARTMENT OF REGULATORY AGENCIES
Board of Chiropractic Examiners
COLORADO STATE BOARD OF CHIROPRACTIC EXAMINERS RULES AND REGULATIONS
3 CCR 707-1
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Rule 12 Misleading, Deceptive, False, or Unethical Advertising
A.	Chiropractors are responsible for the content of their advertising.
B.	The following types of advertising constitute misleading, deceptive, false, or unethical advertising pursuant to § 12-33-117(1)(i), (p) and (3)(a):
1.	The misleading use of a claim regarding board certification or of an unearned or non-health degree in any advertisement or any claim that is likely to cause confusion or misunderstanding as to the credentials, education, or licensure of a healthcare professional;
2.	Advertising that has the effect of intimidating or exerting undue pressure;
3.	Advertising that uses unsubstantiated testimonials;
4.	Advertising that creates an unjustified expectation or guarantees a cure;
5.	Advertising that offers gratuitous services or discounts in a manner that is  deceiving to the public;
6.	Advertising of free or discounted x-ray services; or
7.	Advertising that is otherwise misleading, deceptive, or false.
8.	It must be clear to the public that the advertisement is from a doctor of chiropractic.
C.	At the time any type of advertisement is placed, the chiropractor must possess, scientifically valid research that would substantiate the truthfulness of any assertion, omission, or claim set forth in the advertisement. Scientifically valid research includes applied research, basic research, and field-initiated research in which the rationale, design, and interpretation are soundly developed in accordance with principles of scientific research.
Rule 13	Advertisement of Free or Discounted Services
A.	Advertisement by licensee of free or discounted services shall be deemed false or misleading pursuant to Section 12-33-117(1)(i), C.R.S., unless:
1.	Such advertising claims are truthful and detailed as to specific services provided for free or at a discounted price; and
2.	Prior to the performance of the free or discounted evaluation and the consultation regarding that evaluation, the licensee shall provide the patient with a legible typed or computer generated written prepaid treatment contract describing what services are being provided free or at a discounted price. This prepaid treatment contract description shall also indicate the price of other services which may be offered for a fee, in conjunction with the free service, but that are not included in the offer for free or discounted services. The licensee shall maintain a signed written prepaid treatment contract typed or computer generated copy in the patient’s file.
B.	No separate charge shall be made for the professional evaluation of the free or discounted diagnostic tests whether such professional evaluation is made at the time of the initial office visit or at a later date.
C.	The free service or reduced fee differential shall not be billed to a third-party payer for reimbursement.
D.	Pre-paid and monthly treatment plans must include the following, in writing, signed by the patient with a copy given to the patient:
1. The total costs/fees that the patient will incur and the method and timing of payment(s),
	2. Description of what services and products are included. Any additional fees or costs must be explained to the patient in advance and recorded in the patient records.
	3. Description of the time frame or the number of treatments that the plan covers.	4. How special circumstances such as extended absences, new injury or illness are handled.
	5. Statement that there is no claim or representation of a guarantee of results, outcome, or the cure of a particular condition.
	6. The pre-payment plan must include a written explanation, signed by the patient, on how the unused portion of funds are calculated, or prorated, should the patient complete care early or discontinue care due to the patient’s choice, doctor’s choice, moving, or new injury or condition. The written explanation must be clearly labeled “Refund Policy” and explained in plain language. The explanation must include a table of calculations that illustrates the amount of refunds or amount owed in the event of the pre- paid plan’s early termination.
7. A history, physical exam, and diagnosis in accordance with generally accepted standards of practice is required prior to the sale of any prepaid plan.
Rule 15 Procedures and Diagnostic Tests that are Unproven and Require Informed Consent
A.	When an unproven diagnostic test or procedure is provided, the chiropractor must obtain the written informed consent of the patient or the patient’s legal representative.
B.	The following criteria will be used to determine, by a preponderance of evidence, whether a diagnostic test or procedure is unproven:
1.	Whether the test or procedure is taught as part of the regular curriculum of at least one college of chiropractic approved by the Council on Chiropractic Education.
2.	Whether the test or procedure is based upon anatomical, physiological and/or structural relationships which can be verified through standard diagnostic procedures.
3.	Whether the test or procedure has been supported by a body of evidence using scientifically valid methodology and whether the test or procedure has had periodic review by the Board based on current research as evidenced by:
a.	Publication in a peer reviewed professional or scientific journal (e.g. Spine, Journal of Manipulative and Physiological Therapeutics (JMPT), Bone and Joint Surgery).
b.	Supportive preliminary results in a peer reviewed journal.
c.	Investigation in progress, sponsored by an agency independent of the procedure’s proponents and/or developers.
d.	Hypothesis clearly derived from supportive literature published in peer reviewed journals or texts.
C.	Informed consent shall consist of the following: the patient shall be notified in writing that the diagnostic test or procedure has been designated “unproven” by the Board and that its effectiveness has not been demonstrated.
D.	The patient shall be required to sign a written consent form before a licensee may use a diagnostic test or procedure designated “unproven.” The consent form shall indicate conspicuously that the diagnostic test or procedure anticipated for use has been designated “unproven” by the Colorado State Board of Chiropractic Examiners and that permission is granted by the patient to proceed. A copy of this signed consent form shall be given to the patient for the patient’s retention.
E.	Procedures, diagnostic tests, protocol, analysis or methodology that are unproven and require informed consent include, but are not limited to:
1.	Soft or cold laser for uses not approved by the Food and Drug Administration.
2.	Reams Procedure.
3.	Iridology.
4.	Reflexology.
5.	Contact reflex analysis.
6.	Diagnostic spinal ultrasound for the use of diagnosing paraspinal muscle inflammation, posterior joint swelling, nerve root inflammation, or other spinal pathology in the adult population.
7.	Any practice system, analysis, method, or protocol that does not include the complete assessment, evaluation, or diagnosis of the condition to be treated before beginning treatment of the patient.
8.	Any practice system, analysis, method or protocol, that relies upon diagnostic methods that are not generally recognized or accepted within the profession or that do not have scientific validity.
9.	Any practice system, analysis, method, or protocol, that is represented as a means of attaining spiritual growth, comfort, or well-being.
Rule 19 Safety Training for Unlicensed Chiropractic Personnel
A.	As provided for in §12-33-202, C.R.S., the Board hereby establishes standards for unlicensed chiropractic personnel to operate a machine source of ionizing radiation (x-ray machine) or to administer such radiation to a patient for diagnostic purposes.
B.	In order to qualify to operate an x-ray machine or to administer such radiation to a patient, unlicensed chiropractic personnel must successfully complete a Board approved course that satisfies the following requirements:
1.	Basic radiological guidelines - 5 hours.
2.	Operator and patient safety - 5 hours.
3.	Practical and clinical experience in radiographic production, beam imaging formation, density, contrast, filtration, collimation, processing techniques, chart selection, positioning, examinations, high speed film selection, film marking, film storage, and darkroom procedures - 14 hours.
C.	Any licensed chiropractor employing unlicensed chiropractic personnel to operate an x-ray machine or to administer such radiation to a patient shall maintain written verification of successful completion and training which must include:
1.	A certificate with the name and authorized signature of the agency/educational institution or individual which provided the training;
2.	Name and signature of the unlicensed person who successfully completed the education and training;
3.	Verification of completion of hours specified in subsection B;
4.	Date of completion; and
5.	The original of the written verification shall be maintained in the personnel file and a copy shall be provided to the unlicensed person upon successful completion of the education and training.
D.	No chiropractor shall allow any unlicensed person to operate an x-ray machine or to administer such radiation to any patient unless such unlicensed person has met the standards set forth herein. Any chiropractor who fails to comply with the provision of this rule may be subject to disciplinary action by the Board as provided for in §12-33-117, C.R.S.
E.	As provided for in §12-33-128, C.R.S., the Board hereby establishes standards for unlicensed chiropractic assistants to deliver chiropractic services. Any person, under the direct supervision of a chiropractor, assisting a chiropractor in the delivery of chiropractic services is required to have the requisite skills and training in those areas in which they are assisting. The supervising chiropractor must be readily available to provide immediate assistance if necessary. Appropriate training may be determined by the supervising chiropractor. The supervising chiropractor is responsible for:
1.	ensuring chiropractic assistants possess the requisite skills and training to assist in the delivery of the chiropractic services;
2.	all actions of the chiropractic assistants and may be subject to discipline by the Board as a result of those actions as provided for in §12-33-117, C.R.S.; and
3.	maintaining records of chiropractic assistant’s training.