1. As used in this section, the following terms mean:

(1) “Approved health care provider”, a person holding a current and active license as a physician and surgeon under this chapter, a chiropractor under chapter 331, a dentist under chapter 332, a podiatrist under chapter 330, a physician assistant under this chapter, an advanced practice registered nurse under chapter 335, or any licensed and registered physician, chiropractor, dentist, or podiatrist practicing in another jurisdiction whose license is in good standing;

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(2) “Consult” or “consultation”, communication by telephone, by fax, in writing, or in person with the patient’s personally approved licensed health care provider or a licensed health care provider of the patient’s designation.

2. A physical therapist may evaluate and initiate treatment on a patient without a prescription or referral from an approved health care provider, provided that the physical therapist has a doctorate of physical therapy degree or has five years of clinical practice as a physical therapist.

3. A physical therapist may provide educational resources and training, develop fitness or wellness programs, or provide screening or consultative services within the scope of physical therapy practice without a prescription or referral from an approved health care provider.

4. (1) A physical therapist shall refer to an approved health care provider any patient whose condition at the time of evaluation or treatment is determined to be beyond the scope of practice of physical therapy. The physical therapist shall not provide physical therapy services or treatment after this referral has been made.

(2) A physical therapist shall refer to an approved health care provider any patient who does not demonstrate measurable or functional improvement after ten visits or thirty days, whichever occurs first. The physical therapist shall not provide further therapy services or treatment after this referral has been made.

(3) (a) A physical therapist shall consult with an approved health care provider if, after every ten visits or thirty days, whichever occurs first, the patient has demonstrated measurable or functional improvement from the course of physical therapy services or treatment provided and the physical therapist believes that continuation of the course of physical therapy services or treatment is reasonable and necessary based on the physical therapist’s evaluation of the patient. The physical therapist shall not provide further physical therapy services or treatment until the consultation has occurred.

(b) The consultation with the approved health care provider shall include information concerning:

a. The patient’s condition for which physical therapy services or treatments were provided;

b. The basis for the course of services or treatment indicated, as determined from the physical therapy evaluation of the patient;

c. The physical therapy services or treatment provided before the date of the consultation;

d. The patient’s demonstrated measurable or functional improvement from the services or treatment provided before the date of the consultation;

e. The continuing physical therapy services or treatment proposed to be provided following the consultation; and

f. The professional physical therapy basis for the continued physical therapy services or treatment to be provided.

(c) Continued physical therapy services or treatment following the consultation with and approval by an approved health care provider shall proceed in accordance with any feedback, advice, opinion, or direction of the approved health care provider. The physical therapist shall notify the consulting approved health care provider of continuing physical therapy services or treatment and the patient’s progress at least every ten visits or thirty days after the initial consultation unless the consulting approved health care provider directs otherwise.

(d) The provisions of this subdivision shall not apply to physical therapy services performed within a primary or secondary school for individuals within ages not in excess of twenty-one years.

5. The provision of physical therapy services of evaluation and screening pursuant to this section shall be limited to a physical therapist, and any authority for evaluation and screening granted within this section may not be delegated. Upon each reinitiation of physical therapy services, a physical therapist shall provide a full physical therapy evaluation prior to the reinitiation of physical therapy treatment. Nothing in this subsection shall be construed as to limit the ability of physical therapists or physical therapist assistants to provide physical therapy services in accordance with the provisions of this chapter, and upon the referral of an approved health care provider. Nothing in this subsection shall prohibit an approved health care provider from acting within the scope of their practice as defined by the applicable chapters of RSMo.

6. No person licensed to practice, or applicant for licensure, as a physical therapist or physical therapist assistant shall make a medical diagnosis.

7. A physical therapist shall only delegate physical therapy treatment to a physical therapist assistant or to a person in an entry level of a professional education program approved by the Commission on Accreditation in Physical Therapy Education (CAPTE) who satisfies supervised clinical education requirements related to the person’s physical therapist or physical therapist assistant education. The entry-level person shall be under the supervision of a physical therapist.