Direct Access, Referral Requirements, and Practice Settings
What the exam tests
This domain covers direct access, when a referral is required, and how setting changes the PT's obligations. The key is that direct access is not unlimited practice.
Direct access and referral
New Mexico allows patients to seek physical therapy without a physician referral under the Act's direct-access provisions. The PT must still screen for red flags, practice within scope, and refer to a physician or other appropriate provider when the condition is outside PT scope, fails to improve, or requires medical evaluation. The Act and Board rules may impose limits on treatment without a referral; apply the current statutory limit rather than a generic rule.
Practice settings
Outpatient clinics, acute care, home health, schools, and telehealth each carry setting-specific supervision, documentation, and consent rules. In home health, the PT must ensure the home is safe and the plan is appropriate. In schools, educational and medical goals may differ. Telehealth requires licensure in the patient's location and a secure platform.
Worked example
A patient with calf pain walks into an outpatient clinic without a referral. The PT screens and finds unilateral swelling, warmth, and a recent immobilization history. The PT suspects deep vein thrombosis, does not treat, and sends the patient for emergency medical evaluation. The PT documents the screening, the referral, and the reason for not initiating care.
Traps that cost marks
Do not treat indefinitely without a referral if the Act requires one after a period or if the patient is not progressing. Do not assume direct access covers every condition. Do not ignore setting-specific supervision rules. Do not provide telehealth to a patient located in a state where you are not licensed.