Professional Practice Standards

About 30 minutes · Rules 64B7-23.001, 64B7-23.007 and 64B7-23.009(3), F.A.C.; s. 456.057, F.S.; s. 480.033(15)(f), F.S. (cross-reference)

10.1 The rules behind everyday practice

Chapters 1 through 9 described how a person enters the profession and stays licensed. This chapter is about the work itself, the hour a client spends with you. Many of the Board's practice rules were adopted in a single package effective February 1, 2022, in Chapter 64B7-23 ("Massage Therapy Practice"). They turn the Act's general phrases ("patient information before and during treatment.">assessment," "informed consent," "drape") into specific duties. Together with s. 456.057 (patient records and confidentiality), they describe the professional standard of care in practical terms.

A note on how this chapter relates to the next ones. This chapter teaches the duties: what to do before, during and after a treatment. Chapter 18 later shows how the Board treats failures of those duties as misconduct and negligence under Rule 64B7-23.011, and Chapter 16 covers sexual misconduct. Here we focus on doing it right.

10.2 The vocabulary: Rule 64B7-23.001

Rule 64B7-23.001 defines the terms the other practice rules use. Learn them precisely, because the rest of the chapter depends on them.

• Patient: any person presenting as a client to receive massage therapy treatment. The Board uses the word patient even for a wellness client; the legal duties are the same.
• Health goal: the desired overall progressive improvement in the patient's condition, as stated by the patient.
• Treatment goal: the desired improvement from specific treatment, as stated by the patient.
• assessment, planned treatment and outcomes.">Treatment plan: a written document describing (a) the patient's subjective reason for treatment, health goals and treatment goals; (b) the objective assessment method or methods used; (c) assessment outcomes, including indications and contraindications; (d) the treatment to be administered, including the number of treatments, the duration of each and the expected outcomes; and (e) the outcomes of each administered treatment.
• Massage therapy assessment (or "assessment"): the determination of the course of treatment as an ongoing, systematic process of gathering patient information, made before providing any treatment and in accordance with Rule 64B7-23.007.
• Massage therapy treatment (or "treatment"): massage therapy performed on a patient using techniques, modalities or skills determined by assessment to be appropriate for the patient.
• Indication: evidence that a proposed treatment is likely to have a positive impact on the patient's condition.
• Contraindication: evidence that a proposed treatment may pose a health risk to the patient or have a negative impact on the patient's condition.
• Drape: an inviolable barrier applied to the patient's body for treatment, of sufficient size to provide the patient with personal privacy, security and warmth, such as a hospital gown, sheet, blanket, towel or clothing.
• Draping: the act of applying a drape or drapes to the patient's body for treatment.
• Place of practice: defined in Chapter 11 with the rules on where you may work.

Notice two themes in the definitions. First, goals are defined as stated by the patient: the treatment is built around what the client says they want. Second, treatment is defined as what assessment determines to be appropriate. The sequence is built into the vocabulary: assess first, then treat.

10.3 Designing an intake that does its job

The patient information before and during treatment.">assessment rule asks for a review of goals and of indications and contraindications, using appropriate methods. The first method on the Board's list is the patient health intake form. A well-designed form turns a legal duty into a routine that takes a few minutes. A poorly designed form produces paper and no information.

Begin with the person. The form should collect the demographic information needed to tell one record from another, such as the client's name and contact information, and the date. It should also collect the information that lets you contact the client in an emergency, if the client chooses to provide it.

Ask for goals in the client's words. The rule defines health goals and treatment goals as stated by the patient. Leave space for the client to write what she hopes to gain, and then talk with her about it. A client who writes "relax" and a client who writes "turn my head without pain while driving" are asking for different sessions, and the first conversation is where you learn the difference.

Ask about health in plain language. The form should ask about conditions, surgeries, injuries, medications and allergies in a way that clients can understand. The purpose is to identify contraindications, which the rule defines as evidence that a proposed treatment may pose a health risk or have a negative effect. A question that a client does not understand will not produce a useful answer, so avoid technical language where plain words will do. Give clients a way to say that they do not know, and a way to ask for explanation.

Leave room for what the form did not anticipate. An open question, such as "Is there anything else I should know before we begin?", lets clients mention concerns that no checklist predicted.

Keep it proportionate. A form that takes forty minutes to complete discourages candor and wastes the session. A form that takes three minutes may miss something important. Aim for the length that your services and clients require, and review the form periodically.

Read it, then talk about it. The form is a starting point for the interview, not a substitute for it. A therapist who collects the form and never reads it has not completed an assessment in the sense the rule requires. Read each form before the session, mark anything that needs a question, and ask.

Update it. The assessment is an ongoing process. At return visits, ask what has changed since the last session, and record the answer.

Treat the form as a record. The intake form becomes part of the patient care record. Store it securely, and apply the confidentiality rules described later in this chapter.

10.4 Assessment before treatment: Rule 64B7-23.007

Chapter 2 told you that the Act includes "massage therapy patient information before and during treatment.">assessment" in the licensed role. Rule 64B7-23.007 says what an assessment must do and contain.

Purpose. A massage therapist "must complete a massage therapy assessment to determine whether any proposed massage therapy treatment poses a significant health risk to the patient." The rule frames assessment as a safety step first. It is not a sales intake or a formality; its job is to catch the contraindication before the treatment causes harm.

Required content. An assessment must include:

1. A review of the patient's health goals and treatment outcome goals; and
2. A review of indications and contraindications for any proposed treatment, using appropriate assessment methods.

Methods. The rule lists methods that "may" be used, so the therapist selects what is appropriate to the client and the proposed work:

• (a) patient health intake forms;
• (b) the patient's stated level of health;
• (c) patient interview, including stated goals;
• (d) patient observation;
• (e) palpation;
• (f) orthopedic testing;
• (g) muscle testing;
• (h) joint mobilization, stretching and range-of-motion measurement;
• (i) postural analysis;
• (j) gait assessment;
• (k) functional limitations assessment;
• (l) pain scale evaluation;
• (m) reviewing the report of a referring practitioner; and
• (n) use of a quality-of-life assessment tool.

The list is permissive. No single method is mandatory, but the assessment must be adequate to the purpose: reviewing goals and screening for contraindications. A therapist who gives a client a form and never reads it, or who skips the interview because the client is in a hurry, has not completed an assessment in the sense the rule requires.

Remember the limit from Chapter 3: assessment determines the course of massage therapy treatment. It is not a medical diagnosis.

Ongoing. The definition calls assessment an "ongoing, systematic process." A new complaint mentioned mid-session, a client's report of pain during a technique, or a change in health between visits means the assessment is not finished. Reassess when circumstances change, and record what you find.

10.5 Choosing assessment methods that fit the client

The Board's list of patient information before and during treatment.">assessment methods contains fourteen items, and the rule says they may be used, which means the therapist selects among them. Good professional judgment is largely about choosing wisely. The list is easier to use when you group it.

Methods that gather information by asking. These include the health intake form, the patient's stated level of health, the patient interview including stated goals, pain scale evaluation, a quality-of-life assessment tool and the report of a referring practitioner. They are used at nearly every first visit, because they cost little and reveal much.

Methods that gather information by looking. Patient observation, postural analysis and gait assessment fall here. Watching how a client walks into the room, sits and moves tells you things she may not think to say.

Methods that gather information by touch and movement. Palpation, orthopedic testing, muscle testing, joint mobilization, stretching and range-of-motion measurement, and functional limitations assessment belong in this group. They require training and care. A therapist should use only the methods in which she is competent, as Chapter 3 explained, and should stop if a test provokes pain or a surprising finding.

Matching method to purpose. A client who comes for a general relaxation session may need only an intake form, an interview and observation. A client who comes with a limited range of motion in the shoulder, or whose goal is to return to a sport, may need more, including range-of-motion measurement and functional assessment. A client who arrives with a referring practitioner's report should have the report reviewed. The question for each client is whether the methods used are adequate to review her goals and to screen for contraindications.

Knowing when assessment stops treatment. Sometimes the assessment itself reveals that treatment should not go forward. Signs of acute illness, an unexplained swelling, a report that a physician has restricted certain work, or symptoms that suggest an emergency are reasons to modify the plan, refer or decline. The model of Chapter 3 applies: notice, stop or modify, refer and record.

Assessment is not diagnosis. Each method should be used to decide what massage therapy treatment is appropriate. The therapist describes what she observes and what she plans to do. She does not name diseases or conditions as though she were a physician. A statement such as "the tissue along your shoulder feels tight, and I will focus there" is within scope. A statement such as "you have a pinched nerve" is not.

10.6 Informed consent

The Act's regulation of the therapist-client relationship rests on the principle that the client decides. patient's agreement to treatment after understanding what it involves.">Informed consent means the client agrees to treatment after understanding what it involves. Three points from the rules follow.

Consent to treatment. The Board's rule on misconduct and negligence (Rule 64B7-23.011, Chapter 18) treats failure to obtain informed consent for treatment from the patient, or from the patient's parent or guardian, as a violation. That wording reveals who may consent: the patient, or for a minor or a person who cannot consent, the parent or guardian. The consent must be informed, which means you have explained what you will do, and why, in terms the patient can understand.

Explaining the plan. The assessment, planned treatment and outcomes.">treatment plan definition includes the treatments to be administered, their number and duration, and the expected outcomes. Those are the facts the client needs to consent meaningfully. A client who learns during the session that the work will involve techniques or areas they did not expect has not given informed consent to them.

Credentials, for complementary or alternative treatment. Chapter 3 covered the additional disclosures of the therapist's training when treatment is offered as complementary or alternative care. Those disclosures, and the notation of how they were made, are part of consent in that setting.

10.7 Talking through consent

patient's agreement to treatment after understanding what it involves.">Informed consent is a conversation before it is a signature. The rules require that consent be informed, and the best way to make it informed is to speak plainly and listen well. The examples below are models for the kind of language that helps. They are not required wording, and you should adapt them to your own voice and your clients.

Before the first session. "Before we begin, I would like to tell you what to expect. I will start with a few questions about your health and what you hope to get from today's session. Then I will explain what I plan to do and how I will drape you. You can ask questions at any point, and you can ask me to change anything or stop at any time."

Explaining the plan. "Based on what you told me, I plan to work on your upper back and shoulders with moderate pressure for about fifty minutes. I expect that you may feel looser afterward. If anything feels uncomfortable, tell me and I will adjust."

Checking understanding. "Does that sound right to you? Is there anything you would like me to avoid or do differently?" Listening to the answer is as important as asking the question. A client who hesitates, looks uncertain or changes the subject may not yet have given informed consent.

Consent is continuing. A client who agrees at the start may change her mind during the session. Check in occasionally, especially before moving to a new area or technique. "I am going to move to your neck now. Is that all right?" A client who says stop, or who asks you to avoid an area, must be respected.

Who consents. The rule on misconduct and negligence refers to consent from the patient or from the patient's parent or guardian. When a client is a minor or cannot give consent herself, ask the Board how the rules apply and obtain consent from the person who has the authority to give it. Do not assume that a parent's agreement by telephone is enough, or that a friend of the client can consent for her.

Language and understanding. If a client does not speak the language you use, or has difficulty understanding, take extra care. Use plain words, check understanding and consider whether the session should wait until communication is adequate. Consent that the client did not understand is not informed.

Record the consent. The assessment, plan, outcomes and consent.">patient care record should include the informed consent and the patient's signature. For undraping, the rule requires written specific informed consent noted in the treatment plan, as the next sections explain.

10.8 Draping

Draping is where professional boundaries meet physical practice, and the Board has defined it carefully.

What a drape must be. An "inviolable barrier" of sufficient size to give personal privacy, security and warmth: a sheet, blanket, towel, gown or clothing. "Inviolable" means the barrier is not to be breached. A drape that slips and is left in a compromised position, or that is too small for the client, fails the definition.

What appropriate draping covers. Under Rule 64B7-23.001(10), appropriate draping includes coverage of the genitalia, groin, femoral triangle, anus, buttocks, gluteal cleft, and breasts at all times, unless the patient gives specific treatment after understanding what it involves.">informed consent to be undraped and written specific informed consent is noted in the patient's assessment, planned treatment and outcomes.">treatment plan.

Break that sentence into its requirements:

• At all times. The coverage is continuous, not just at the start of the session.
• Unless specific informed consent. The consent must be specific to the undraping, not a general agreement to massage. The patient must understand what areas will be uncovered and why.
• Written, and noted in the treatment plan. A verbal "that's fine" is not enough. The written consent belongs in the treatment plan so that it is part of the record.

The link to the statute. The Act's definition of sexual activity (Chapter 2, s. 480.033(15)(f)) includes the intentional removal of any drape without specific written informed consent of the patient. The Board's drape rule and the statutory definition fit together: correct draping protects the client, and failing to follow it can be treated as something far more serious than a technical lapse (Chapter 16).

Explaining draping. Good practice, and the rule's expectation, is that you explain your draping technique to the patient before the session so the client knows what to expect and can ask questions. The Board's misconduct rule lists failing to explain draping as a failure (Chapter 18).

Practical points. Describe the draping plan at intake. Keep the drape secure as you work; uncover only the area being treated. Stop and re-cover if a client shifts. If a technique needs access to a covered area and the client agrees, obtain specific informed consent in writing, note it in the plan, and do not go beyond what was consented to.

10.9 Draping as a daily skill

The rule defines draping carefully, and the skill is one that therapists practice every day. Doing it well is a matter of habit and of respect for the client. The points below turn the rule into routine.

Explain before the client undresses. Tell the client how you will drape and what you will uncover. Explain where you will step out of the room while she gets on the table, and how she should position herself. Many clients are nervous about being undressed, and a clear explanation puts them at ease.

Give privacy to undress. Leave the room, and tell the client when you will knock before entering. The rule does not require a particular wording, but it does require a drape that provides personal privacy, security and warmth.

Choose the drape to fit. The rule requires a barrier of sufficient size. A small towel on a large client does not provide privacy or security. Keep a variety of sheets, blankets or towels, and use the ones that fit.

Keep the barrier intact. The rule calls the drape inviolable. Uncover only the area you are working on, and re-cover it when you are finished. If a drape slips, restore it. Do not tuck a drape in ways that intrude on covered areas, and do not move it in ways that expose areas the client has not agreed to uncover.

Work around the drape. Many techniques can be performed through or around a drape. If a technique seems to require access to a covered area, ask whether another approach will achieve the goal. In most cases there is one.

Think about the client's positions. When the client turns over, hold the drape to maintain privacy. Teach the client to turn while you hold the sheet up, or step away. Maintaining coverage during position changes is part of coverage at all times.

When a client asks to be uncovered. A client may say that she is comfortable being uncovered. The rule requires patient's understanding of what and why.">specific treatment after understanding what it involves.">informed consent, in writing, noted in the assessment, planned treatment and outcomes.">treatment plan, before any area that the rule lists is undraped. The safest practice is to explain that the rule requires coverage at all times, offer alternatives that keep the area covered and, if the client still wishes to proceed and the work is within your scope, follow the written consent process. If you are uncomfortable, you may decline. A therapist is never obligated to do work that she believes is unsafe or inappropriate.

When something goes wrong. If a client's drape slips while you are not working in that area, restore it without comment or with a brief, calm word. If a client becomes upset about draping, stop, listen and ask what she needs. Record the event and your response.

Why the standards matter. Draping is the boundary between treatment and exposure. Every therapist who follows the rule consistently protects clients and the profession's reputation. Every therapist who treats the rule casually risks serious harm and serious consequences, as Chapter 16 will show.

10.10 The patient care record

Records are your proof that the standards above were met. Rule 64B7-23.009(3) describes the content of a patient information before and during treatment.">assessment, plan, outcomes and consent.">patient care record for a therapist providing complementary or alternative treatment under s. 456.41 (Chapter 3 covered the disclosure duties that come with that setting). The same elements form a sound model for any record, and they closely follow the treatment-plan definition. The record must include:

• (a) Demographic information sufficient to differentiate the record from other patient care records;
• (b) The method or methods of assessment used;
• (c) A description of the patient's condition;
• (d) The proposed treatment plan to be administered and any contraindications;
• (e) The expected outcomes of the treatment or treatments in the plan;
• (f) The expected duration of treatment or treatments in the plan; and
• (g) The informed consent and signature of the patient to receive the treatment.

Combine this with the treatment-plan definition in Section 10.2 and you have a record that documents the full sequence: reason for visit and goals, how you assessed, what you found, what you proposed, what the client agreed to, and what happened afterward (the plan's element (e), the outcome of each treatment). Record keeping rules specific to establishments (what an establishment must keep about employees and clients, and for how long) are covered in Chapter 13.

10.11 Writing a record that tells the story

The record is your proof that the standards were met. A record that is clear, complete and timely protects the client by preserving information about her care, and it protects the therapist by documenting what happened and why. The rule describes the elements, and the habits below help you meet them.

Write at the time or soon after. A record written soon after the session is more accurate than one written days later. Make a habit of writing before the next client arrives, or at the end of the day at the latest.

Be specific. "Worked on back" says little. "Moderate pressure along both sides of the upper back and shoulders for about twenty minutes; client reported relief; avoided the area near the left shoulder blade because of reported tenderness" says much more. Specific records are more useful to you at the next session, and more persuasive if a question ever arises.

Use the client's words for goals and complaints. The rule defines goals as stated by the patient. Quote or paraphrase the client accurately.

Record what you observed, not what you assumed. State what you saw, felt or heard. Avoid diagnostic labels. "Client reports pain on turning the head to the left; range of motion appears reduced" is an observation. "Client has a cervical disc problem" is a diagnosis, outside your scope.

Document the plan and the outcome. The treatment.">assessment, planned treatment and outcomes.">treatment plan includes the number and duration of treatments and the expected outcomes, and the record should show the outcome of each administered treatment. After each session, note how the client responded, what you did and what you recommend next.

Document consent and any special consent. Record that informed consent was obtained and how. If any undraping was agreed to, the written specific consent must be noted in the plan.

Document referrals and communication. If you referred the client to another provider, note it. If you communicated with another provider, note the date, the person and the content, and whether the client gave written authorization.

Correct errors openly. If you make an error, correct it in a way that shows the correction was made and when. Do not erase or destroy the original entry. A record that has been altered without a trace invites suspicion.

Keep it legible and organized. A record that cannot be read or found is of little use. Whether you keep paper or electronic records, use a system that keeps each client's information together and secure.

A note about format. The rule lists the elements that a record must contain and does not mandate a particular format. Some therapists use a structured approach, such as recording the client's subjective report, objective findings, treatment performed and plan. Any format that captures the required elements can work.

10.12 Confidentiality and release of records: section 456.057

Section 456.057 is the general Florida law on patient records for health care practitioners. Massage therapists are "health care practitioners" within s. 456.001(4) (Chapter 2), so it applies to you. The section was amended most recently in 2026 (ch. 2026-165), so confirm the current text when you rely on it. The main rules are:

Who is the records owner. A "records owner" is a practitioner who generates a medical record after examining or treating a person; a practitioner to whom records are transferred; or a practitioner's employer, if the employment contract designates the employer as the records owner (s. 456.057(1)). Know who the owner is in your setting: if you work for an establishment, the contract matters.

The patient's access. A licensed practitioner who examines or treats a person must, "upon request of such person or the person's legal representative, furnish, in a timely manner, without delays for legal review, copies of all reports and records relating to such examination or treatment" (subsection (6)). The furnishing "shall not be conditioned upon payment of a fee for services rendered." You may charge the copying cost: no more than the actual cost of copying, including reasonable staff time, or the amount set by board rule (subsection (17)).

The default rule: confidentiality. Under subsection (7)(a), records "may not be furnished to, and the medical condition of a patient may not be discussed with, any person other than the patient, the patient's legal representative, or other health care practitioners and providers involved in the patient's care or treatment, except upon written authorization from the patient." Subsection (7)(c) adds that information disclosed to a practitioner by a patient in the course of care is confidential and may be disclosed only to other practitioners and providers involved in the patient's care, if allowed by written authorization, or if compelled by subpoena at a deposition, evidentiary hearing or trial for which proper notice has been given.

Exceptions without written authorization. Records may be furnished without written authorization in these circumstances (subsection (7)(a)1.–6.):

1. To any person, firm or corporation that has procured or furnished the care or treatment with the patient's consent.
2. When a compulsory physical examination is made under Rule 1.360 of the Florida Rules of Civil Procedure (copies go to both defendant and plaintiff).
3. In any civil or criminal action, unless otherwise prohibited by law, upon the issuance of a subpoena from a court of competent jurisdiction and proper notice to the patient (or legal representative) by the party seeking the records.
4. For statistical and scientific research, if the information is abstracted to protect the patient's identity, or with written permission.
5. To a regional poison control center for treating a poison episode and for required data reporting.
6. To the Department of Children and Families, for investigations of or services in cases of abuse, neglect or exploitation of children or vulnerable adults. Records requested under s. 39.301(9)(a) must be furnished within 14 days after the request.

A subpoena alone, without proper notice to the patient, does not authorize release under item 3. A request from a friend, an employer, a family member or a curious colleague does not fit any exception and requires the patient's written authorization.

No marketing use. Absent a specific written release permitting use of patient information for solicitation or marketing the sale of goods or services, "any use of that information for those purposes is prohibited" (subsection (7)(b)). Using your client list to promote a product or service, without a written release, violates this provision.

Disclosures about your own defense. Subsection (7)(d) allows disclosure, notwithstanding the general rule, in a medical negligence action or administrative proceeding where the practitioner is or reasonably expects to be named as a defendant, and in consultation with the practitioner's own attorney when the practitioner reasonably expects to be deposed, called as a witness, or to receive discovery requests. This protects your ability to defend yourself.

Department access. Subsection (8) lets the Department obtain patient records by subpoena without patient authorization in certain investigations, including where there is reasonable cause to believe a practitioner practiced below the required level of care, skill and treatment and reasonable attempts were made to obtain a release. Records the Department obtains are used only for disciplinary proceedings and are confidential (subsection (9)).

Your duty to protect the record. Records owners "shall develop and implement policies, standards, and procedures to protect the confidentiality and security of the medical record," and employees of records owners "shall be trained" in them (subsection (10)). Records owners must also keep a record of all disclosures of information to third parties, including the purpose, and the third party is prohibited from further disclosure without the patient's written consent (subsection (11)). In practice: have a written confidentiality policy, train everyone who touches records, and log every release.

When a practice ends. A records owner who is terminating practice, retiring or relocating, and no longer available to patients, must place an advertisement in the local newspaper or notify patients in writing, and offer them the opportunity to obtain a copy of their record (subsection (12)). The records owner must also notify the appropriate board office, specifying who the new records owner is and where the records can be found (subsection (13)). The new owner must provide a complete copy on written request (subsection (14)). Where a practitioner dies, becomes incapacitated, or abandons records, the Board (with Department approval) may appoint a custodian of the records (subsection (20)).

Enforcement. Licensees who violate the section "shall be disciplined by the appropriate licensing authority" (subsection (15)), and the Attorney General may enforce it against records owners who are not otherwise licensed, through injunctive relief and fines not exceeding $5,000 per violation (subsection (16)).

The section does not state a minimum retention period for a practitioner's records. Retention periods for establishment records are in Chapter 13, and you should ask the Board whether any additional retention requirement applies to your setting.

10.13 Confidentiality in the places it actually fails

The statute states confidentiality clearly. In practice, confidentiality is lost not through dramatic disclosures but through small habits. A therapist who knows where leaks occur can prevent them.

The telephone. A caller who asks whether a person is a client should not receive the answer without the client's patient's written permission to release records or discuss her condition.">written authorization. As the scenario of the curious employer showed, even confirming that someone is a client discloses information the section protects. A calm script helps: "I am not able to confirm or discuss who is or is not a client. If you would like to leave a message, I will pass it along if appropriate."

Text messages and email. Appointment reminders and scheduling are routine, but messages may be seen by others on shared devices or intercepted. Limit the content of messages to what is necessary, ask clients how they prefer to be contacted, and avoid sending clinical information through channels you cannot secure.

The front desk and waiting room. Conversations at a reception desk can be overheard. Keep voices low, avoid discussing a client's condition where others can hear and do not leave schedules, intake forms or notes where other clients can see them.

Shared offices and shared devices. If several therapists use the same space, make clear whose records are whose, and do not leave records open on shared screens. Lock screens and use passwords.

Social media. A therapist who posts about a day's work, a client's progress or a photograph that shows a client may disclose protected information. Do not post anything that identifies a client or describes her condition without her written permission. Even a post that does not name the client may be recognized by her friends.

Conversations with colleagues. A therapist may discuss a client with another practitioner who is involved in the client's care. Discussing a client casually with a colleague who is not involved is not covered by that provision. When you seek advice about a difficult case, remove details that identify the client.

Marketing. The statute prohibits using patient information for solicitation or marketing without a specific written release. Do not use your client list for mailings about products or promotions unless each client has signed a release that permits it.

Disposal. Records that are no longer needed should be destroyed in a way that protects the information. Because the rules reviewed here do not state a retention period for a practitioner's records, ask the Board before destroying anything, and follow any retention rule that applies to your setting.

Policies and training. The statute requires records owners to develop and implement policies to protect the confidentiality and security of records, and employees must be trained. A short written policy, a training session when someone joins and a yearly reminder satisfy the spirit of the requirement.

10.14 Records requests and transitions

Clients ask for their records for many reasons: to see another provider, to understand their care, or simply because they have a right to see them. The statute requires that a practitioner furnish copies on request, in a timely manner, without delays for legal review, and without conditioning the furnishing on payment of a fee for services rendered.

When a request arrives, a sound routine has five steps. Confirm the identity of the person asking, and confirm that she is the patient or the patient's legal representative. Ask for the request in writing, if you wish, so that you have a record of what was asked and when, but do not use the requirement of writing to delay. Prepare the copies promptly. Charge no more than the actual cost of copying, including reasonable staff time, or the amount set by board rule. And log the disclosure, including the date, the recipient and the purpose.

Practice transitions deserve forethought. A therapist who is retiring, relocating or closing must notify patients in writing or by newspaper advertisement and offer them a chance to obtain their records. She must notify the Board office of the new records owner and the location of the records. A therapist who is moving from one practice to another, or from an employer to independent practice, should ask who the records owner is under her contract, because the answer determines who has the duties.

Finally, think about the unexpected. A therapist who dies, becomes incapacitated or abandons her records leaves clients without access to their care history, and the statute allows the Board to appoint a custodian. A therapist can reduce the risk by arranging in advance who would handle her records if she could not.

10.15 Frequently asked questions

Do I need a written patient information before and during treatment.">assessment, planned treatment and outcomes.">treatment plan for every client, even a relaxation client? The rule defines the treatment plan as a written document and requires an assessment before treatment. The practical way to meet both is to document the goals, the assessment, the planned treatment and the outcome for every client. Ask the Board if you are unsure how the rules apply to a particular service.

Can a client sign a general consent form that covers undraping? The rule requires specific informed consent to be undraped, noted in writing in the treatment plan. A general form that does not identify the areas and the reason is unlikely to meet the standard. Use a specific consent process, and explain it to the client.

May I tell a client's physician about her treatment? The statute allows discussion with other practitioners involved in the patient's care, and it allows disclosure with written authorization. If you are unsure whether the physician is involved in the client's care, obtain written authorization.

May I keep records only on my phone? The statute requires policies to protect the confidentiality and security of records. A phone can be lost or shared. If you keep electronic records, use passwords, secure storage and backups, and consider whether the system you use meets your duty to protect the record.

What if a client asks me to destroy her records? The rules reviewed here do not give a client the right to require destruction, and retention may be required for other reasons. Ask the Board before destroying any record.

A police officer asks for a client's records. What should I do? The statute allows release in a civil or criminal action on a subpoena from a court with proper notice to the patient, and in certain other circumstances. Do not release records on an informal request. Ask to see the legal document, and consult an attorney if you are unsure.

10.16 More scenarios to practice

Scenario F: The form nobody read. A therapist hands every new client an patient's health information and goals.">intake form, files it without reading and begins the session. A client later reports that she mentioned a recent surgery on the form. What is the problem?

Discussion. The rule requires a review of indications and contraindications using appropriate methods. A form that no one reads does not accomplish the review. The therapist should read each form before the session, ask about anything that raises a concern and record what was discussed. A recent surgery is a clear example of information that may require changing the plan or referring the client.

Scenario G: The general consent. A spa has clients sign a form that says, "I consent to all massage therapy treatment, including any necessary undraping." A therapist relies on it to uncover a client's gluteal area. Is the form enough?

Discussion. No. The rule requires specific informed consent to be undraped, and written specific informed consent must be noted in the assessment, planned treatment and outcomes.">treatment plan. A general statement that covers any undraping does not identify the areas or the reason. The therapist should have kept the area covered, or explained the proposed work and obtained specific written consent. Removing a drape without specific written consent falls within the Act's definition of sexual activity.

Scenario H: The social media post. A therapist posts a photograph of a happy client with the caption "Another shoulder injury fixed!" The client did not sign a release. What problems arise?

Discussion. The post discloses that the person is a client and describes her condition, which the confidentiality provisions protect, and it may use patient information for marketing without a written release. The caption also suggests that the therapist treats and fixes an injury, language that raises scope and advertising concerns taught in Chapters 3 and 17. She should remove the post, apologize to the client and adopt a policy requiring written release before any client appears in marketing.

Scenario I: The shared tablet. Three therapists in a studio use one tablet for client notes, without passwords. A client's neighbor, who also receives care at the studio, sees another client's note on the screen. What should the studio do?

Discussion. The statute requires records owners to implement policies to protect confidentiality and security and to train employees. The studio should adopt passwords, separate access, lock screens and a written policy, train everyone and log what happened. It should also consider whether the affected client should be told.

Scenario J: The closing studio. A therapist who owns a small studio is closing in six weeks and moving out of state. She has about two hundred client records. What steps does she need to take?

Discussion. She must notify patients in writing or by newspaper advertisement that she is closing, and offer them a chance to get copies of their records. She must notify the Board office who the new records owner is and where the records can be found. She should arrange secure transfer, log any disclosures and respond promptly to any request for copies.

Chapter summary

The Board's practice rules in Chapter 64B7-23 and section 456.057 describe a sequence of duties: assess, obtain consent, treat within the plan, record and protect. The vocabulary in Rule 64B7-23.001 is built around the patient's stated goals and around treatment.">assessment that determines which treatment is appropriate. A treatment plan is a written document describing the patient's reason and goals, the assessment methods and outcomes, the planned treatment and the outcome of each treatment.

Rule 64B7-23.007 requires an assessment before treatment to determine whether a proposed treatment poses a significant health risk. The assessment must review goals and review indications and contraindications using appropriate methods, and it is an ongoing process. It is a safety step and is not a diagnosis.

Informed consent means the client agrees after understanding what the treatment involves. Consent comes from the patient or from the patient's parent or guardian. Appropriate draping covers the genitalia, groin, femoral triangle, anus, buttocks, gluteal cleft and breasts at all times, unless the patient gives specific informed consent to be undraped and written specific informed consent is noted in the treatment plan. The drape must be an inviolable barrier of sufficient size to provide privacy, security and warmth.

A patient care record includes demographic information, assessment methods, a description of the condition, the proposed plan and contraindications, expected outcomes and duration, and the patient's informed consent and signature. Under section 456.057, records are confidential, released only with written authorization or under listed exceptions such as a subpoena with proper notice to the patient. A practitioner must furnish copies on request without conditioning them on payment of a fee for services, may charge only the actual cost of copying, may not use patient information for marketing without a written release, must implement policies to protect records and log disclosures, and must notify patients and the Board when a practice ends.