NC Chiropractic Jurisprudence cheat sheet

Chiropractic is licensed and regulated under Chapter 90, Article 8 of the North Carolina General Statutes; the NC Board of Chiropractic Examiners adopts rules under Title 21, Chapter 2 of the NC Administrative Code.

The Board consists of licensed chiropractors plus a public member appointed by the Governor; it issues, renews, suspends, and revokes licenses and investigates complaints.

Grounds for discipline include unprofessional conduct, practicing beyond scope, fraud in obtaining a license, impairment, and failure to comply with continuing education requirements.

License renewal is annual; renewal requires payment of the fee and completion of the continuing education hours set by Board rule, and lapsed licenses may not be practiced on.

Continuing education must include Board-specified subject areas; documentation of CE must be retained and produced on audit, and false CE reporting is itself a disciplinary offense.

Licensees must report certain events to the Board, including criminal convictions and adverse disciplinary actions taken by other jurisdictions, within the time the Board requires.

A chiropractor may not practice under a name other than the name on the license without Board approval, and advertising must not be false, deceptive, or misleading.

The Board may issue cease-and-desist orders and seek injunctive relief against unlicensed practice; practicing chiropractic without a license is a criminal offense.

Patient records must be retained for the period set by Board rule and released to the patient or the patient's authorized representative as required by law.

The statutory scope is the detection and correction of vertebral subluxation complexes and spinal adjustments, plus the physical examination, diagnosis, and treatment of the human body by manual or mechanical means.

Chiropractors may order and interpret diagnostic imaging and laboratory tests reasonably necessary for the diagnosis and treatment of their patients.

Adjustment and manipulation of the spine and extremities are core authorized procedures; soft tissue techniques, physiotherapeutic modalities, and exercise instruction fall within the scope when used for diagnosed conditions.

Prescribing legend drugs and performing major surgery are outside the chiropractic scope in North Carolina; limited authority exists only where a specific statute or rule expressly grants it.

A chiropractor must refer the patient to an appropriate licensed provider when the condition is outside the chiropractic scope or when the patient is not responding within a reasonable time.

Informed consent must be obtained before treatment; consent must disclose the nature of the procedure, the material risks, and reasonable alternatives, including no treatment.

A chiropractor may not represent that chiropractic treatment can cure conditions it cannot cure, and may not guarantee results.

Supervision of chiropractic assistants and students is the licensee's responsibility; unlicensed personnel may not perform procedures reserved to the licensed chiropractor.

The chiropractor of record is responsible for the diagnosis, the plan of care, and the quality of care delivered in the office, including care delegated to staff.

The initial evaluation must document a chief complaint, history of present illness, relevant past medical and family history, review of systems, and the physical and chiropractic examination findings.

Diagnostic imaging and laboratory results must be documented with the clinical indication for ordering them and the interpretation that supports the diagnosis.

Each visit note must record the date, subjective report, objective findings, the assessment, the treatment delivered, and the patient's response to care.

The plan of care must state the diagnosis, treatment goals, expected frequency and duration of care, and objective criteria for re-evaluation and discharge.

Progress must be documented against measurable goals; continuation of care requires documented objective improvement or a documented rationale for continued trial of care.

Informed consent, including the risks and alternatives discussed, must be documented in the record and signed by the patient where required by office policy or Board rule.

Records must be legible, authenticated by the treating chiropractor, and corrected only by a dated addendum that preserves the original entry.

Records must be released on proper written authorization; a summary may be provided in place of the full record where the law permits, and fees for copies are limited by statute.

Retention periods run from the date of the last professional service; records of minors and of patients involved in litigation may require longer retention.

The chiropractor-patient relationship is fiduciary; the patient's welfare takes precedence over the chiropractor's financial interest.

Sexual contact with a current patient is prohibited and is grounds for discipline, regardless of purported consent.

Exploiting the patient relationship for financial gain, including unnecessary treatment, upcoding, or billing for services not rendered, is unprofessional conduct.

Patient confidences may be disclosed only with written authorization or as required or permitted by law, such as mandated reporting or a court order.

Dual relationships that impair professional judgment, and treating family members or self in ways that compromise objectivity, should be avoided or carefully documented.

Advertising and testimonials must be truthful and not misleading; claims of superior outcomes or guaranteed results are prohibited.

Impairment from alcohol, drugs, or illness must be addressed; practicing while impaired is a disciplinary offense and may trigger Board-ordered evaluation.

Fee splitting, kickbacks, and paying for patient referrals violate professional standards and may violate state and federal law.

A chiropractor must cooperate fully with a Board investigation and must not alter or destroy records after a complaint is filed.