On January 1, 2014, AB 1000 went into effect. The Direct Access bill provided, among other things, authorization for a patient to directly access physical therapy services up to 45 days or 12 visits before requiring a physician to approve the plan of care for the patient. The physical therapy must be within the physical therapist’s scope of practice and the physical therapist was subject to a number of conditions, one of which was,”provide oral and written notice to the patient as specified in the statute.”
pain-assessment-form-final
The written notice is specifically addressed in Business and Professions Code, section 2620.1(e):

When a person initiates physical therapy treatment services directly, pursuant to this section, the physical therapist shall not perform physical therapy treatment services without first providing the following notice to the patient, orally and in writing, in at least 14-point type and signed by the patient:

Direct Physical Therapy Treatment Services

You are receiving direct physical therapy treatment services from an individual who is a physical therapist licensed by the Physical Therapy Board of California.

Under California law, you may continue to receive direct physical therapy treatment services for a period of up to 45 calendar days or 12 visits, whichever occurs first, after which time a physical therapist may continue providing you with physical therapy treatment services only after receiving, from a person holding a physician and surgeon’s certificate issued by the Medical Board of California or by the Osteopathic Medical Board of California, or from a person holding a certificate to practice podiatric medicine from the California Board of Podiatric Medicine and acting within his or her scope of practice, a dated signature on the physical therapist’s plan of care indicating approval of the physical therapist’s plan of care and that an in-person patient examination and evaluation was conducted by the physician and surgeon or podiatrist.

__________
Patient’s Signature/Date

So, if you are a physical therapist in California accepting direct access patients, in order to comply with the law, you must make sure that your standard, “Physical Therapy Consent” form is meeting the statutory requirement. That statutory requirement would be the above language in the above required font size. While as nitpicky and silly it would be for the Physical Therapy Board of California to pursue license discipline against a physical therapist for failing to meet this standard, it would seemingly be just as silly for a physical therapist not to take the steps necessary to come into compliance under the statute. So, please make sure to check your form!