Maryland State Board of Chiropractic Examiners 4201 Patterson Ave., Ste. 301

Baltimore, Maryland 21215

Office: 410-764-4726

Fax: 410-358-1879

CHIROPRACTIC ASSISTANT (CA) TRAINING PROGRAM GUIDE AND REQUIREMENTS

BEFORE YOU IGNORE OR DISCARD THIS 5 PAGE GUIDE TO THE CA

PROGRAM, IT IS STRONGLY SUGGESTED THAT YOU FAMILIARIZE YOURSELF

AND THOSE EMPLOYEES AFFECTED IN YOUR PRACTICE WITH THE

FOLLOWING INFORMATION.

STAGE 1

□ Supervising Chiropractor submits the Application for CA Training Program (Stage 1,

Pages 1 & 2) & The CA Applicant/Trainee Application (Pages 3 & 4 with copy of the

Fingerprint Receipt) in one submission packet to the Board via Fax or USPS Mail. Ensure

with the fax that the photo ID has been copied lighter and then faxed for legibility.

□ Supervising Chiropractor’s Office receives the Board Authorization Letter to Commence

with Training. (Potential CA Trainees may engage in the 20 hours of observation in the

interim of the Board’s Request to Employ application review). Generally, barring any

background issues; the Board’s authorization response time is within 48 hours

STAGE 2

□ Supervising Chiropractor submits the 4 Month Review Form located on the website under the

Applications and Forms link or accessed from the provided link below:

• https://health.maryland.gov/chiropractic/Documents/4monthr.pdf

within 4 months of date of Board Authorization Letter to commence with training response to

the request to employ into the CA Training Program)

STAGE 3 – Only can be submitted at completion of CA Program Training and the Applicant/Trainee

has a completed: An accurate log with 520 hours recorded and signed off by applicable Supervising

Chiropractor(s) and has the 103 hours certificate of coursework by an approved provider while

ensuring that the CPR at Stage 2 is still valid along with reporting any criminal history accurately. Stage 3 is the final stage to which a CA trainee applicant submits the Board Application for Registration

COMPLETED and postmarked by the applications deadline dates posted on the website.

□ C.A. Trainee Submits the CA Application for Registration/Examination – Making copy

for the professional office and/or Supervising Chiropractor before mailing

◆ Completed Application Form

◆ Photos – Two (2x2) photographic passport style pictures on white background which

can be obtained at any CVS, Walgreens, Walmart, etc.

◆ Fee – Business Check, Money Order or Bank’s cashier check

◆ Criminal History Attestation of truthful information – Signed in presence of an official

Notary and Notarized containing notary seal or stamp.

◆ Official Certificate of Completion of 103-hour Coursework signed by the instructor

◆ Copy of completed clinical Logs totaling 520 hours and signed by the supervising

chiropractor(s) whom trained on the listed modalities/techniques

◆ Certificate of Moral Character by individual whom will be contacted attesting to the

CA’s moral character Rev. 2019-03-17 AC

CHIROPRACTIC ASSISTANT (CA) TRAINING PROGRAM

KEY TERMS & RELEVANT REGULATORY INFORMATION

COMAR - http://www.dsd.state.md.us/comar/SubtitleSearch.aspx?search=10.43.07.%2a

10.43.07.01

.01 Definitions.

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) "Applicant" means a person who is undergoing training to become a chiropractic assistant.

(2) “Board” means the Board of Chiropractic Examiners.

(3) "Chiropractic assistant" means an individual who is registered by the Board to perform the duties authorized

under this chapter.

(4) "Direct supervision" means supervision provided by a supervising chiropractor who is personally present and

immediately available in the area where the procedures are performed to give aid, direction, and instruction when

certain procedures or activities are performed.

(5) "Supervising chiropractor" means a chiropractor licensed by the Board in chiropractic with the right to

practice physical therapy as set forth in Health Occupations Article, §3-301(c), Annotated Code of Maryland, and

approved as a supervising chiropractor by the Board.

10.43.07.03

.03 Responsibilities of the Supervising Chiropractor.

The supervising chiropractor shall:

A. Submit:

(1) The required Board Request to Employ form before undertaking any hands on training or coursework with any

chiropractic assistant applicant; and

(2) All other Board-required reports and forms in a timely manner as determined by the Board.

B. Notify the Board and course instructor or instructors of any change in status of any chiropractic applicant or

assistant within 10 days of the change, including:

(1) Reasons for the change in status;

(2) Training received by the applicant or assistant;

(3) Hours completed by the applicant or assistant; and

(4) The applicant's or assistant's forwarding address;

C. Maintain accurate, legible, and comprehensive records of all clinical training provided to the chiropractic applicant

or assistant, including, but not limited to:

(1) Dates and times and duration of training as described in Regulation .05 of this chapter;

(2) Modalities;

(3) Equipment used; and

(4) Any other information as directed by the Board;

D. Immediately produce the records described in §C of this regulation upon request or audit by the Board;

E. Promptly:

(1) Report a chiropractic applicant or assistant not making satisfactory training progress; and

(2) Report before the Board as directed regarding the details of the training program issue;

F. Maintain competency in knowledge of applicable laws and regulations and successfully complete any

jurisprudence requirements that may be directed by the Board;

G. Ensure that all patient records accurately and legibly reflect the extent and degree of the involvement or assistance

of the chiropractic applicant or assistant;

H. Submit the in-service training hours and verification of chiropractic applicant or assistant competency on a form

provided by the Board within 30 days of completion of training or transfer of the chiropractic applicant or assistant to

another supervising chiropractor;

I. Be fully responsible for the safe and competent performance of the chiropractic applicant or assistant at all times;

and

J. Provide direct supervision to not more than five chiropractic assistants or applicants.

10.43.07.08

.08 Activities That May Be Performed by Chiropractic Applicants and Assistants

Without Direct Supervision.

Only a chiropractic applicant or assistant may perform the following activities without the direct supervision of a

supervising chiropractor:

A. Taking the height, the weight, and vital signs of a patient and recording them in the patient record;

B. Assisting in the dressing, undressing, and draping of a patient;

C. Removing and applying assistive and supportive devices;

D. Observing treatments and modalities as authorized by the supervising chiropractor;

E. Providing preprinted non-patient specific health and chiropractic concepts and information that has been approved

and reviewed by the supervising chiropractor; and

F. Taking patient histories.

10.43.07.09

.09 Activities That May Be Performed by Chiropractic Applicants and Assistants

Under Direct Supervision of a Supervising Chiropractor.

A chiropractic applicant or assistant may perform the following activities only under the direct supervision of a

supervising chiropractor who is in the treatment area:

A. Functional activities of daily living and hygiene;

B. Gait practice and ambulation;

C. Demonstration, administration, and observation of therapeutic exercises as prescribed by a supervising

chiropractor;

D. Assist in moving a patient within the treatment area;

E. Contrast baths;

F. Hot and cold packs;

G. Hubbard tank;

H. Infrared, ultraviolet irradiation, non-laser light therapy, and non-ablative therapeutic laser;

I. Muscle stimulation;

J. Electrotherapy;

K. Paraffin baths;

L. Traction therapy;

M. Ultrasound;

N. Whirlpool;

O. Diathermy;

P. Therapeutic massage, if licensed under Health Occupations Article, Title 6, Annotated Code of Maryland; and

Q. Mechanical or computerized examination procedures for the sole purpose of collecting data subject to the

following conditions:

(1) All data will later be used and interpreted by the chiropractor to form a diagnosis and treatment plan; and

(2) No test may be performed that requires diagnosis or interpretation as part of the data collecting or testing

procedure.

10.43.07.10

.10 Chiropractic Applicant or Assistant Prohibited Acts.

A chiropractic applicant or assistant may not engage in any of the following activities:

A. Communicate an evaluation or diagnosis to a patient;

B. Perform an act requiring the professional skill or judgment of a licensed chiropractor;

C. Take x-rays or position patients for x-rays;

D. Perform orthopedic or neurological tests;

E. Engage in dietary or nutritional advice or counseling; or

F. Other acts not within the chiropractic applicant or assistant's specified scope.

10.43.07.11

.11 Practicing Without Registration.

A. Except as otherwise provided in this chapter, a person may not practice, attempt to practice, or offer to practice as

a chiropractic assistant in this State unless registered by the Board.

B. A person may not serve as a chiropractic applicant or assistant unless approved by the Board.

10.43.07.12

.12 Penalties for Violations of This Chapter.

A. Violations of these regulations may result in disciplinary action against the supervising chiropractor as set forth in

Health Occupations Article, §3-313, Annotated Code of Maryland.

B. A person practicing as a chiropractic assistant without being registered, except as provided in these regulations, is

guilty of a misdemeanor, and may be fined $5,000 or imprisoned for 1 year, or both.

C. A chiropractic assistant and an applicant for registration is subject to the Board's disciplinary authority under

Health Occupations Article, §3-313, Annotated Code of Maryland.

*NOTE: THE FOLLOWING PAGES (1, 2, 3, *4, & *Requirement for pages 5, 6, & 7) ARE

THE REQUIRED PAGES TO THE “REQUEST TO EMPLOYAPPLICATION” FOR THE

CA TRAINING PROGRAM. PLEASE READ THE 2 PARTS FORM ONE PACKET

REGARDING THE “REQUEST TO EMPLOY APPLICATION” IN ITS ENTIRETY AND

COMPLETE THE REQUIRED FORMS WITH THE REQUIRED DOCUMENTION.

INCOMPLETE APPLICATIONS ARE SUBJECT TO BE RETURNED FOR FULL

SUBMISSION.

STAGE 1

To be Completed by Supv. D.C.

Pages 1 & 2and attach to CA Applicant's pgs 3 & 4 "Request to Employwith req. documentationCA Applicant to complete pgs. 3, 4, & 7 per directions.

Maryland State Board of Chiropractic Examiners 4201 Patterson Ave., Suite 301Baltimore, MD 21215 Telephone: (410) 764-4726 Fax: (410) 358-1879 www.health.maryland.gov/chiropractic

CHIROPRACTIC APPLICANT"REQUEST TO EMPLOY"

APPLICATION FOR CA TRAINING PROGRAM

Please type into the form or print all information.This form is to be completed by the Supervising Chiropractor. See COMAR 10.43.07.02 (on Board’s website)

regarding requirements for achieving supervising chiropractor status.

I / We hereby attest that (each box must be checked):

□ Applicant is a high school graduate.

□ Applicant is at least 18 years of age.

□ Applicant is a U.S. citizen or is legally residing in the U.S. on a valid work VISA.

□ Applicant is sufficiently proficient in the English language to effectively communicate

with patients.

□ I understand that Applicant must complete Board-approved, provider-level, CPR course.

I will submit proof of completion along with a copy of the issued CPR card or

certification no later than 4 months from the Applicant’s date of hire. I understand that

the Applicant’s failure to submit proof of completion within the time prescribed will

result in immediate suspension from the CA training program, absent a waiver or

exemption by the full Board.

□ I understand that Applicant must enroll in a Board-approved, CA 103-hour course of

instruction within 4 months of Applicant’s date of hire. I will submit proof of enrollment

to the Board once the Applicant becomes enrolled or no later than 4 months from the

Applicant’s date of hire. I understand that the Applicant’s failure to complete the course

within one (1) calendar year of the date of hire will result in immediate suspension from

the CA training program, absent a waiver or exemption from the full Board.

□ I understand that Applicant must complete all hands-on, clinical and didactic training and

apply to take the CA examination within one (1) calendar year from the Applicant’s date

of hire determined by the Board's, "Authorization Letter to Commence with Training". I

understand that failure to do so will result in the Applicant’s immediate suspension from

the CA training program, absent a waiver or exemption from the full

1

I, ____________________________________, Supervising Lic. No.: _________ request to employ, sponsor, ______________________________________, CA Trainee Applicant Secondary Supv. D.C. (if applicable) _____________________________________Lic. No._______

□ I understand that I may train/supervise no more than five (5) CAs or CA

applicant/trainees.

□ I understand and agree that the clinical in-service curriculum of 520 hours consists of 20 hours of observation and 500 hours of direct supervision in modalities and procedures. I agree to maintain accurate and legible records of all training hours during the training.

□ I agree to complete and forward the "4 Month Review Form" and related documents to the

Board 4 months from the authorization to commence with training but not more than 5-7 days late.

□ I understand that I may not begin training the Applicant until I receive the authorization

letter to do so from the Board.

□ I agree to submit a Change of Status form to the Board within 10 days of the Applicant’s

departure from my practice regardless of the reason for the departure.

I currently employ the following CA applicants/trainees and registered CAs:

Name Date of Hire Location Status (Trainee or Reg. CA)

*Any CA trainee who has been employed by you for at least 4 months and has not yet enrolled in a

Board-approved course of instruction is SUSPENDED from the CA training program and may not

engage with patients. You may petition the Board for an extension, however, the CA trainee remains

suspended unless/until the Board grants an extension in writing.

I/We have read and understand my/our duties and obligations as a Supervising Chiropractor(s) as set forth in this

"Request to Employ" and current with all applicable Maryland statutes and regulations. I/We attest that the

foregoing information is true and correct to the best of my knowledge, information, and belief.

Primary Supervising D.C. - Print Name Legibly Signature Date

Practice Full Address

Phone Email

____________________________________

Fax #

2

________________________________________________________________________________________________________________________________________________________

_____________________________ _______________________________Secondary Supervising D.C. - Print Name Legibly Signature Date (if applicable)

Maryland State Board of Chiropractic Examiners 4201 Patterson Ave., Suite 301

Baltimore, MD 21215

Telephone: (410) 764-4726

Fax: (410) 358-1879

www.health.maryland.gov/chiropractic

STAGE 1CA Trainee Completes Page(s) 3 & 4Follow Directions for Page 5-7 AND submit Fingerprint Req. Receipt

CHIROPRACTIC APPLICANT"REQUEST TO EMPLOY"

APPLICATION FOR C.A. TRAINING PROGRAM

Please type directly into this form or print all information. Attach these pages (3 & 4 and the required documentation) to page 1 & 2 of the CA Application for Hire which pages 1 & 2 should be completed by the Supervising Chiropractor. This form is to be completed by the CA Applicant/Trainee. This form must be notarized.

This application must include at time of submission, All of the following:

□

□

Proof of Identity - one of either (copy of driver’s license, valid State ID or recent passport); Proof of Age - one of either (copy of birth cert., driver’s license or valid State ID).

Proof of High School Graduation/GED (copy of high school or college diploma or

final transcript indicating graduation). If foreign school, documents must have official

translation attached and documentation of ability to work in U.S. (if applicable)

*Incomplete applications will be returned in their entirety which may affect applicable deadlines.

*An applicant may do the 20 hours of observation upon awaiting the Board's Authorization Letter to commence withtraining. However, a CA Applicant may not commence working or training with patients until/unless the Supervising D.C. has received the aforementioned written authorization letter from the Board. Please contact the Board if you have any questions regarding the application process.

Name:

Address:

Street City State Zip

Phone: Email:

SSN: Date of Birth: Place of Birth:

High School:

CHIROPRACTIC OFFICE INFORMATION BELOW:

Supervising Chiropractor’s Name: __________________________________________________

Office Address:

Office Phone: __________________________Office Fax No.:____________________________

3.

Copy of Criminal History Record Check - Fingerprinting Receipt Must be attached to this application.

Year Graduated/GED: _____________ Will the Trainee be working with more than one Supervising D.C.? Yes or No (circle one)List Secondary D.C.:_____________________

Please answer truthfully each of the following. Forgotten or omitted answers will delay approval.

1. Are you proficient in the English language such that you can communicate

effectively with patients?

Yes No

2. Have you ever been arrested, charged with a crime, or pled guilty, nolo contendre, no

contest, or been convicted or received probation before judgment for any criminal act,

including DWI or DUI? Yes No If "Yes" (regardless of the timeframe),immediately contact the Clerk's Office of the Criminal Court for which you appeared to obtainyour court records. If you have an upcoming court case regarding any of the aforementioned;disclose that information in a letter attached to this application. In addition, you are providedwith a resource link: https://www.mdd.uscourts.gov/

3. Have you ever been employed in the healthcare profession? Yes If yes, please describe in detail on a separate sheet.

4. Have you ever been licensed or registered in any profession? Yes

N o

No

5. Have you ever had a license, registration, or certification suspended, revoked or

otherwise sanctioned? Yes No If yes, please describe in detail

on a separate sheet.

6. Have you ever been employed by a chiropractor or chiropractic office in Maryland, in

any capacity, and been terminated for cause? Yes

in detail on a separate sheet.

No If yes, please describe

7. Have you ever been an abuser of or dependent on alcohol, prescription medication

or illegal controlled substances?

Yes No If yes, please describe in detail on a separate sheet.

8. Are you a United States citizen? Yes No If No, please explain in detail how

you acquired authorization to work in the U.S. and attach copies of related documentation

and your current work permit.

9. Are you a veteran or the spouse of a veteran of the U.S. Armed Forces?

Yes No If so, please provide the branch of service and date of discharge (if

applicable and a copy of your military ID.

I attest that my answers to the foregoing questions are true and correct to the best of my knowledge, information, and belief under the penalty of law. * I have attached a copy of my Fingerprinting receipt to this application.

Print Your Full Name Applicant’s Signature Date

r

4

NOTARY SEAL (required) Notary's Signature: __________________________

Larry Hogan, Governor ∙ Boyd K. Rutherford, Lt. Governor ∙ Robert R. Neall, Secretary

Maryland State Board of Chiropractic Examiners

Criminal History Records Check

A full Criminal History Records Check (CHRC) is a requirement for a license or registration from the Maryland Board of Chiropractic Examiners. A full background check includes both State and FBI checks. The Department of Public Safety and Correctional Services, Criminal Justice Information System (CJIS) oversees Criminal History Record Checks. History record checks are conducted by being fingerprinted.

CJIS AUTHORIZATION #: 050011922

FBI ORI #: MD 920519Z

REASON FINGERPRINTED: Chiropractic License or Registration

TYPE OF CHECK: Governmental Licensing/Certification

The cost is $55.00 ($31.25 background check and $23.75 fingerprinting service). However, the cost of fingerprinting services from private providers can and will vary. The fee must be paid directly to the provider. Check with the provider to determine what forms of payment are accepted.

All applicants for licensure or registration in Maryland will be required to submit fingerprints. This can be accomplished in two ways depending on if you are a Maryland resident or not. In order to comply with the regulations and not delay the the processing of an application for a license or registration, follow the directions on the next page(s).

For additonal information, contact CJIS at 410-764-4501 or visit www.dpscs.maryland.gov/publicservs/fingerprint.shtml.

FOR Maryland Residents - BEFORE MAILING COMPLETED APPLICATION TO THE BOARD

1.

2. When you have your fingerprints taken you will be given a receipt for payment.Enclose a copy of that RECEIPT when remitting the application for licensure or registration.

3. Once the results of the background checks are received that part of the applicationprocess will be completed in accordance to the Board regulations and policies. Foradditional information on providers and the CJIS process, contact CJIS at 410-764-4501 orvisit www.dpscs.maryland.gov/publicservs/fingerprint.shtml

FOR Out of State Applicants1. Before submitting a completed application, contact the Board (410) 764-

4738 to request the “Application For Criminal History Records Check” pre- authorized fingerprint stock card to be mailed directly to you. This is the onlyfingerprint card that will be accepted by CJIS and by the Board. The receipt (proofof fingerprinting not more than 30 days from your application submission)MUST be enclosed within your application packet to avoid delays.

2.

3.

4.

Your results will be electronically transmitted to the Board and can take up to 2 weeks.However this will not preclude you from sitting and taking the required MD exams provided you had attached a copy of the receipt for having the fingerprinting completed per directions of the application process.

Follow the directions in this packet. You will need to have the Maryland State Board of Chiropractic Examiners CJIS Authorization Number and FBI ORI Number with you when you are fingerprinted. Take the attached form "Livescan Pre Registration Application" already pre-filled with the authorization numbers for In-State residents only. NOTE: OUT OF STATE APPLICANTS CANNOT USE THE ATTACHED LIVE SCAN PRE REGISTRATION APPLICATION ATTACHED TO THESE DIRECTIONS. SEE SECTION TITLED, "FOR OUT OF STATE APPLICANTS".

Maryland Residents take the "Livescan Pre-Registration Application Form attached to this packet with you to be fingerprinted.

Have your fingerprints taken at a location near you. However, private providers feesmay vary. For additional information CJIS at 410-764-4501 or visitwww.dpscs.maryland.gov/publicservs/fingerprint.shtml

Once you have your fingerprints taken, you MUST mail the Board's fingerprint card tothe below address with a check for $31.25 made out to the "CJIS Central Repository."Ensure you attach your check to your fingerprint card. No cash or money orders

Mail To:CJIS Central RepositoryP.O. Box 32708Pikesville, Maryland 21282-2708

Note: