OAR 811-015-0010: Clinical Justification and Standard of Care

An Oregon licensed chiropractic physician provides care for many conditions using a variety of therapeutic procedures, including but not limited to chiropractic adjustment and manipulation. There is one standard of care for all patients, irrespective of the condition, service, or advice provided. All chiropractic physicians licensed under ORS chapter 684 are subject to the following: (1) Clinical justification, within accepted standards and understood by a group of peers, must be shown for all opinions, diagnostic, and therapeutic procedures. The singular accepted standard of care includes obtaining a history that informs the examination, conducting an examination that informs the diagnosis, and using the diagnosis to inform the management plan which includes relevant outcome markers. (2) “Accepted standards” means skills and treatment which are recognized as being reasonable, prudent, and acceptable under similar conditions and circumstances. (3) For neuro-musculoskeletal conditions, all initial and subsequent examinations performed by a chiropractic physician to determine the need for treatment shall include a functional chiropractic analysis. Some combination of at least two of the following PARTS exam constitutes a functional chiropractic analysis: P — Location, quality, and intensity of pain or tenderness produced by palpation and pressure over specific structures and soft tissues; A — Asymmetry of sectional or segmental components identified by static palpation; R — The decrease or loss of specific movements (active, passive, and accessory); T — Tone, texture, and temperature change in specific soft tissues identified through palpation; S — Use of special tests or procedures. (4) Chiropractic physicians shall treat their patients as often as necessary to allow for favorable progress. Evidence-based outcomes management shall determine whether the frequency and duration of curative chiropractic treatment is, has been, or continues to be necessary. Outcomes management shall include both subjective, or patient-driven, information as well as objective, provider-driven, information. In addition, treatment of neuro-musculoskeletal conditions outside of the Oregon Practices and Utilization Guidelines may be considered contrary to accepted standards. Chiropractic physicians treating outside of the Practices and Utilization Guidelines bear the burden of proof to show that the treatment, or lack thereof, is clinically justified. (5) Copies of any independent examination report must be made available to the patient, the patient’s attorney, the treating doctor, and the attending physician at the time the report is made available to the initial requesting party.