COLORADO STATE BOARD OF CHIROPRACTIC EXAMINERS
Proposed 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” (CPR) 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, licensees 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.	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 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 17   Acupuncture clarification for Doctors of Chiropractic Certified in Acupuncture 

C.	The board considers the administration with fine needles of nutritional and botanical medicines for diagnostic and therapeutic purposes by doctors of chiropractic certified in acupuncture, within the scope of practice.

Rule 22  Record Keeping Requirements
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 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.  Any addition to the patient file after the final form shall be signed and dated by the person making the addition.  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.	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 clinically indicated, treatment options/alternatives should be documented.
f.	When referring to another healthcare provider, correspondence may be provided for patient care coordination.
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 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 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.
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.
Rule 28  Regarding Misleading, Deceptive or False Advertising

Doctors of chiropractic should take special care to advertise truthfully and avoid exploitation of their position of trust. Because of the potential consequences of misinformation regarding health care and the importance of the interests affected by the choice of a doctor of chiropractic, chiropractors must avoid misleading the public. Chiropractors are responsible for the contents of their own advertisements and should review such advertisements to assure adherence to ethical standards.

Therefore, doctors of chiropractic shall avoid the following types of advertising:

a.	Claims that the services performed, personnel employed, and/or materials or office equipment used are professionally superior to that which ordinarily performed, employed, and/or used, or that convey the message that one licensee is better than another unless superiority of services, personnel, materials or equipment can be substantiated;
b.	The misleading use of a claim regarding board certification, or of an unearned or non-health degree in any advertisement that is likely to cause confusion or misunderstanding as to the credentials, education, or licensure of a health care professional;
c.	Advertising that has the effect of intimidating or exerting undue pressure;
d.	Advertising that uses unsubstantiated testimonials; 
e.	Advertising that creates an unjustified expectation or guarantees satisfaction or a cure;
f.	Advertising that offers gratuitous services or discounts, the purpose of which is to deceive the public;
g.	Advertising that is otherwise misleading, deceptive or false.