Scope of Practice, Supervision, and Delegation
The evaluation line
The sharpest line in PT law is between evaluation/assessment and intervention. Only the PT performs the initial examination and evaluation, establishes the diagnosis within the PT scope, designs the plan of care, and makes discharge decisions. The PTA implements the plan of care, may modify interventions within that plan, contributes observations that inform a reassessment, and documents the care delivered. The PTA does not establish the plan, does not perform the initial evaluation, and does not independently discharge.
Delegation tiers
- PT → PTA: permitted for interventions within the plan of care, under the supervision level the setting and rule require; the PT retains responsibility for the plan and for reassessment.
- PT/PTA → aide or technician: non-skilled, non-patient-care tasks only (transport, cleaning equipment, clerical work, preparing a treatment area). An aide may not apply a modality, progress an exercise program, or make any clinical decision.
- PT → student: supervision must be on site and the student may not be billed as the treating clinician.
Traps
- A question where the PTA "reassesses and adjusts the plan" - adjusting the plan is out of scope; adjusting an intervention within the plan may be permissible.
- An aide "applying ultrasound while the PT is in the building" - presence of the PT does not make an unskilled task skilled.
- Confusing supervision of a PTA (delegated care) with consultation of a colleague (peer advice, no supervision relationship).
Rule of thumb
Who holds the judgment? If the task requires clinical reasoning about the patient's condition, it belongs to a licensee - and the initial plan belongs to the PT alone.
Worked example: A PT evaluates a post-op shoulder patient and writes a plan. The PTA progresses range-of-motion and reports increased pain. The PTA may hold or modify that session's intervention and must communicate; the PT must reassess and revise the plan.