It may not be necessary to make a full note on every patient visit.

When a physiotherapist has documented a comprehensive assessment, there is a clear treatment plan, and the patient’s condition has not yet changed from the last appointment, an attendance record (documenting that the patient has come to the appointment), it may be enough. An attendance record could just be a check-mark on a set date indicating the patient came for treatment or it may appear in a different way.

However, if the patient’s condition has changed or the therapy is modified there needs to be documentation of this change in the patient’s chart.

If you want a full picture of the patient’s attendance or overall treatment you should ask for the invoices (they can also tell you who provided care and when), the patient record, any exercise sheets or logs and/or a record of attendance which could be captured in the patient chart, on the clinic sign in sheet or in treatment logs.

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We do receive reports from PTs who are concerned that their name and registration number have been used after they have left a practice setting.

Usually the PT finds out from a former colleague or because an insurer has initiated a claims verification audit. In most cases, the clinic is owned by someone who is not a regulated health care provider. We do not often hear of situations where the PT is still working at the practice and their name and registration number is being used without their consent.

The College works with the PT to assist them in deciding how to proceed. They are also advised to use the CHLIA and IBC tip lines.

You should know that PT registration numbers are no longer available in full on the Public Register. The partial number was introduced last year. This was to address the concern that this information could be accessed and used for improper purposes.

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Tele-rehabilitation is the provision of physiotherapy services at a distance, by an information or communication technology such as video conferencing, when an in-person visit is not possible. 

A patient can expect the same safe, effective, and ethical care as an in-person visit and the physiotherapist must comply with all regulatory requirements.  

Tele-rehabilitation may be appropriate if the patient cannot easily access an in-person visit due to a shortage of physiotherapy services available in the region where the patient lives or because of transportation or mobility concerns. Physiotherapists should use their professional judgment to determine if this model of care is the most appropriate available method to deliver physiotherapy care and that the patient is not exposed to any increased risk. Patients and physiotherapists alike need to recognize any limitations that tele-rehabilitation services present including privacy of personal health information, safety of the patient within the context of their home or work environment and the inability to perform a hands-on assessment and subsequent treatment. A physiotherapist may bill for tele-rehabilitation services and the rate is expected to be reasonable and professional within the context of the practice setting.

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A Physiotherapy (or Physical Therapy or PT) Resident has a degree in physiotherapy, has successfully completed a written test of knowledge and is registered to take the next available clinical exam.

They have an experienced Physiotherapist supervising their practice, but PT Residents are registered with the College of Physiotherapists of Ontario, have liability insurance and are accountable for their practice.

They are permitted to assess and treat patients independently, and to bill for their services. Their registration is time limited. You can verify the status of a PT Resident on the College's Public Register. 

Public Register

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No. It is never acceptable to bill in advance of providing the treatment.

Sometimes to make it easier for a client, the PT will provide services and then issue an invoice later. This would be permitted if all of the individual dates of service are listed.

Yes, a physiotherapist must provide an itemized account for services and/or products if the patient or a payer requests one, and it must be provided free of charge.

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The College does not set the rates for physiotherapy care, including care provided by a physiotherapist assistant. The fees charged should be publicly available and a written fee schedule should be made available to the patient before they agree to receive physiotherapy care. Physiotherapists must ensure that fees are not excessive according to our rules.

Fees charged by physiotherapists may vary across Canada. Some PTs will invoice by the half hour or hour, while some bill in 15-minute blocks. We have seen some cases where billing is done by treatment modality. So, it could be that a PT charged less if a physiotherapist assistant provided the care, but this is not the norm.

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No, physiotherapists are not permitted to sell memberships.

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No. In Ontario, physiotherapists are considered primary health care practitioners, so a referral from a doctor is not necessary. Although, sometimes an insurance company may require a doctor's referral.

• Triaging, initial assessment (subjective and some objective components including outcome measures), ongoing assessments to monitor progress including use of objective assessment tools that are available in many software programs and apps.
• Exercise prescription, supervised therapeutic exercise and appropriate progressions
• Home-based modalities, including electrical stimulation and heat and cold applications, as long as the patient has the equipment at their home.
• Self-administered techniques such as soft tissue massage or frictions under the direction of the physiotherapist, including patient education on how to do and at what intensity.
• Support for self-management, education, coaching and reassurance for patients and for caregivers. This includes teaching patient’s families how to assist in performing stretches or guide home exercises.
• Assessment of how patients are functioning and adapting in their home environments, including assessment of fall risks and other functional activities of daily living assessments.
• Bracing, donning, removal and check in on fit and outcomes for bracing. 

Virtual practice is permitted by the College for all other physiotherapy care if the care provided (like any other care) meets all the College standards, and it is in the best interest of the patient. Virtual care is not new and was used by PTs before the pandemic.

Some physiotherapy may be delivered virtually in a group setting, but that does not exempt a physiotherapist from meeting all the College Standards and rules. You can see a list of those rules here.

Therefore, a physiotherapist must do things like:

• Discuss the privacy and confidentiality risks and the precautions taken with each patient.
• Get the patient's consent in the same way they would for an in-person assessment or treatment. In the case of virtual practice, they must be sure the patient understands explicitly how the assessment or treatment will work using technology.
• The PT must document the discussion they had with the patient in the patient's record.
• The Record Keeping Standard applies in the same way whether the care is delivered face-to-face, in a group, or virtually. The patient assessment, diagnosis, goals of the treatment and a treatment plan must be charted. The PT should make it clear in the patient's record and invoice if treatment was delivered virtually and in a group.
• The College cannot recommend physiotherapy fees. All costs must be transparent to the patient and have been agreed to before the service is provided. The invoice or patient record should indicate group treatment and that the treatment was delivered virtually.
• The decision as to whether something is covered by insurance, whether virtual and/or group therapy classes, is the decision of each insurance carrier.

Key take away:

If physiotherapy is delivered virtually, in a group or even one-on-one, all College standards must be met by the physiotherapist in the same way

Please, see some helpful FAQs about telerehabilitation posted on our website.