Direct Access, Patient Referral, and Consultation Requirements
What this domain tests
Questions probe when a PT may treat without a physician referral, when referral or consultation is mandatory, and how the PT documents and communicates with other providers.
Core rules
- Louisiana grants limited direct access: a PT may examine and treat a patient without a physician referral, but the authority is not unlimited. The PT must refer or consult when the condition is outside the PT’s scope, when red flags or non-musculoskeletal findings appear, or when the patient fails to progress.
- The Practice Act and board rules may impose time or visit limits before a referral is required; track the current statutory limit and any condition-specific exceptions.
- A PT may refer a patient to another health care provider when indicated. Consultation with the referring provider should be documented, including the reason, date, and response.
- The PT must not order imaging or prescribe medication; those are medical acts.
Worked example
A patient walks in with low back pain and no referral. The PT evaluates and begins treatment. At the second visit the patient reports progressive leg weakness and loss of bladder control. The PT stops treatment and sends the patient for urgent medical evaluation. Reasoning: direct access permits initial evaluation and treatment, but red flags and conditions outside the PT’s scope require immediate referral.
Traps that cost marks
- Treating direct access as independent practice with no referral ever required.
- Continuing treatment despite red flags because the patient prefers to stay.
- Failing to document that no referral was required or that a referral was made.
- Assuming a PT may order imaging or prescribe medication.
- Missing the statutory time limit before referral.