Supervision Requirements and the OT/OTA Relationship, Including Documentation and Co-Signature Rules
This domain tests who may do what in the OT/OTA relationship and how supervision is documented. Kentucky law defines the OTA as a licensee who assists in occupational therapy under OT supervision; the OT remains accountable for the plan of care and for the quality of delegated services.
Core rules
- The OT performs the initial evaluation, interprets findings, establishes goals, and designs the intervention plan. The OTA implements delegated interventions and reports progress.
- Supervision must be appropriate to patient needs, setting, and the OTA's competence. Board rules and facility policy set the frequency and type of supervision; the OT must be available for consultation and must review the plan as conditions change.
- The OTA may document services delivered. The supervising OT must review OTA documentation and co-sign it when required by board rule or facility policy. Co-signature means the OT reviewed the content, not that the OT personally performed the service.
- If an OTA sees a change in condition, the OTA should report it and obtain OT direction rather than independently revising the plan.
Worked example
An OTA writes a progress note recommending a new transfer technique and implements it without contacting the OT. Even if the technique is reasonable, the OTA has changed the plan without OT authorization. The OT must review the change, revise the plan if appropriate, and document the supervision and rationale.
Traps
Do not assume supervision always means on-site supervision; do not assume co-signature transfers all responsibility away from the OTA; do not let an OTA complete the initial evaluation.