Virginia Department of Health Professions Regulations for Physical Therapy PDF

PTH 105 -- Unit 3 -- HO\#2 +-----------------------+-----------------------+-----------------------+ | | ***Commonwealth of | | | | Virginia*** | | +=======================+=======================+=...

PTH 105 -- Unit 3 -- HO\#2 +-----------------------+-----------------------+-----------------------+ | | ***Commonwealth of | | | | Virginia*** | | +=======================+=======================+=======================+ | | ##### Virginia Depart | | | | ment of Health Profes | | | | sions | | | | | | | | **[Regulations]{.smal | | | | lcaps}** | | | | | | | | **[Governing the | | | | Practice of Physical | | | | Therapy]{.smallcaps}* | | | | * | | | | | | | | **Title of | | | | Regulations: 18 VAC | | | | 112-20-10 et seq.** | | | | | | | | **Statutory | | | | Authority: Chapter | | | | 34.1 of Title | | | | 54.1**of the ***Code | | | | of Virginia*** | | | | | | | | **Revised: May 12, | | | | 2021** | | +-----------------------+-----------------------+-----------------------+ | | 9960 Mayland Drive, | | | | Suite 300 (804) | | | | 367-4674 (TEL) | | | | | | | | Henrico, Virginia | | | | 23233-1463 (804) | | | | 939-5973 (e-FAX) | | | | | | | | [[www.dhp.virginia.go | | | | v]](http: | | | | //www.dhp.state.va.us | | | | ) | | | | [[ptboard\@dhp.virgin | | | | ia.gov]]( | | | | mailto:[email protected] | | | | rginia.gov) | | | | (email) | | +-----------------------+-----------------------+-----------------------+ TABLE OF CONTENTS [TABLE OF CONTENTS 2](#section) [Part I. General Provisions. 4](#part-i.-general-provisions.) [Part II. Licensure: General Requirements. 7](#part-ii.-licensure-general-requirements.) [Part III. Practice Requirements. 11](#part-iii.-practice-requirements.) [Part IV. Renewal or Relicensure Requirements. 14](#part-iv.-renewal-or-relicensure-requirements.) [Part V. Standards of Practice. 18](#part-v.-standards-of-practice.) **CHAPTER 20** **REGULATIONS GOVERNING THE PRACTICE OF PHYSICAL THERAPY** Part I. General Provisions. =========================== 18VAC112-20-10. Definitions. ---------------------------- In addition to the words and terms defined in §§ [[54.1-3473]](http://law.lis.virginia.gov/vacode/54.1-3473/) and [[54.1-3486]](http://law.lis.virginia.gov/vacode/54.1-3486/) of the Code of Virginia, the following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise: \"Active practice\" means a minimum of 160 hours of professional practice as a physical therapist or physical therapist assistant within the 24-month period immediately preceding renewal. Active practice may include supervisory, administrative, educational, or consultative activities or responsibilities for the delivery of such services. \"Approved program\" means an educational program accredited by CAPTE. \"CAPTE\" means the Commission on Accreditation in Physical Therapy Education of the American Physical Therapy Association. \"Compact\" means the Physical Therapy Licensure Compact (§ [[54.1-3485]](http://law.lis.virginia.gov/vacode/54.1-3485/) of the Code of Virginia). \"Contact hour\" means 60 minutes of time spent in continuing learning activity exclusive of breaks, meals, or vendor exhibits. \"Direct supervision\" means a physical therapist or a physical therapist assistant is physically present and immediately available and is fully responsible for the physical therapy tasks or activities being performed. \"Discharge\" means the discontinuation of interventions in an episode of care that have been provided in an unbroken sequence in a single practice setting and related to the physical therapy interventions for a given condition or problem. \"Encounter\" means an interaction between a patient and a physical therapist or physical therapist assistant for the purpose of providing health care services or assessing the health and therapeutic status of a patient. \"Evaluation\" means a process in which the physical therapist makes clinical judgments based on data gathered during an examination or screening in order to plan and implement a treatment intervention, provide preventive care, reduce risks of injury and impairment, or provide for consultation. \"FCCPT\" means the Foreign Credentialing Commission on Physical Therapy. \"FSBPT\" means the Federation of State Boards of Physical Therapy. \"General supervision\" means a physical therapist shall be available for consultation. \"National examination\" means the examinations developed and administered by the Federation of State Boards of Physical Therapy and approved by the board for licensure as a physical therapist or physical therapist assistant. \"Physical Therapy Compact Commission\" or \"commission\" means the national administrative body whose membership consists of all states that have enacted the compact. \"Reevaluation\" means a process in which the physical therapist makes clinical judgments based on data gathered during an examination or screening in order to determine a patient\'s response to the treatment plan and care provided. \"Support personnel\" means a person who is performing designated routine tasks related to physical therapy under the direction and supervision of a physical therapist or physical therapist assistant within the scope of this chapter. \"TOEFL\" means the Test of English as a Foreign Language. \"Trainee\" means a person seeking licensure as a physical therapist or physical therapist assistant who is undergoing a traineeship. \"Traineeship\" means a period of active clinical practice during that an applicant for licensure as a physical therapist or physical therapist assistant works under the direct supervision of a physical therapist approved by the board. \"TSE\" means the Test of Spoken English. \"Type 1\" means continuing learning activities offered by an approved organization as specified in [[18VAC112-20-131]](http://law.lis.virginia.gov/admincode/title18/agency112/chapter20/section131/). \"Type 2\" means continuing learning activities which may or may not be offered by an approved organization but shall be activities considered by the learner to be beneficial to practice or to continuing learning. 18VAC112-20-20. (Repealed.) --------------------------- 18VAC112-20-25. Current name and address. ----------------------------------------- Each licensee shall furnish the board his current name and address of record. All notices required by law or by this chapter to be given by the board to any licensee shall be validly given when sent to the latest address of record provided or when served to the licensee. Any change of name or change in the address of record or the public address, if different from the address of record, shall be furnished to the board within 30 days of such change. 18VAC112-20-26. Criteria for delegation of informal fact-finding proceedings to an agency subordinate. ------------------------------------------------------------------------------------------------------ A. Decision to delegate. In accordance with § [[54.1-2400]](http://law.lis.virginia.gov/vacode/54.1-2400/) (10) of the Code of Virginia, the board may delegate an informal fact-finding proceeding to an agency subordinate upon determination that probable cause exists that a practitioner may be subject to a disciplinary action. B. Criteria for delegation. Cases that may not be delegated to an agency subordinate include, but are not limited to, those that involve: C. Criteria for an agency subordinate. 18VAC112-20-27. Fees. --------------------- A. Unless otherwise provided, fees listed in this section shall not be refundable. B. Licensure by examination. C. Licensure by endorsement. The fee for licensure by endorsement shall be \$140 for a physical therapist and \$100 for a physical therapist assistant. D. Licensure renewal and reinstatement. E. Other fees. Part II. Licensure: General Requirements. ========================================= 18VAC112-20-30. General requirements. ------------------------------------- Licensure as a physical therapist or physical therapist assistant shall be by examination or by endorsement. 18VAC112-20-40. Education requirements: graduates of approved programs. ----------------------------------------------------------------------- A. An applicant for licensure who is a graduate of an approved program shall submit documented evidence of his graduation from such a program with the required application and fee. B. If an applicant is a graduate of an approved program located outside of the United States or Canada, he shall provide proof of proficiency in the English language by passing TOEFL and TSE or the TOEFL iBT, the Internet-based tests of listening, reading, speaking and writing by a score determined by the board or an equivalent examination approved by the board. TOEFL iBT or TOEFL and TSE may be waived upon evidence that the applicant\'s physical therapy program was taught in English or that the native tongue of the applicant\'s nationality is English. 18VAC112-20-50. Education requirements: graduates of schools not approved by an accrediting agency approved by the board. ------------------------------------------------------------------------------------------------------------------------- A. An applicant for initial licensure as a physical therapist who is a graduate of a school not approved by an accrediting agency approved by the board shall submit the required application and fee and provide documentation of the physical therapist\'s certification by a report from the FCCPT or of the physical therapist eligibility for licensure as verified by a report from any other credentialing agency approved by the board that substantiates that the physical therapist has been evaluated in accordance with requirements of subsection B of this section. B. The board shall only approve a credentialing agency that: C. An applicant for licensure as a physical therapist assistant who is a graduate of a school not approved by the board shall submit with the required application and fee the following: D. An applicant for initial licensure as a physical therapist or a physical therapist assistant who is not a graduate of an approved program shall also submit verification of having successfully completed a 1,000-hour traineeship within a two-year period under the direct supervision of a licensed physical therapist. The board may grant an extension beyond two years for circumstances beyond the control of the applicant, such as temporary disability, officially declared disasters, or mandatory military service. 18VAC112-20-60. Requirements for licensure by examination. ---------------------------------------------------------- Every applicant for initial licensure by examination shall submit: 18VAC112-20-65. Requirements for licensure by endorsement. ---------------------------------------------------------- A. A physical therapist or physical therapist assistant who holds a current, unrestricted license in the United States, its territories, the District of Columbia, or Canada may be licensed in Virginia by endorsement. B. An applicant for licensure by endorsement shall submit: C. A physical therapist assistant seeking licensure by endorsement who has not actively practiced physical therapy for at least 320 hours within the four years immediately preceding his application for licensure shall successfully complete 320 hours in a traineeship in accordance with the requirements in [[18VAC112-20-140]](http://law.lis.virginia.gov/admincode/title18/agency112/chapter20/section140/). 18VAC112-20-70. Traineeship for unlicensed graduate scheduled to sit for the national examination. -------------------------------------------------------------------------------------------------- A. Upon approval of the president of the board or his designee, an unlicensed graduate who is registered with the Federation of State Boards of Physical Therapy to sit for the national examination may be employed as a trainee under the direct supervision of a licensed physical therapist until the results of the national examination are received. B. The traineeship, which shall be in accordance with requirements in [[18VAC112-20-140]](http://law.lis.virginia.gov/admincode/title18/agency112/chapter20/section140/), shall terminate five working days following receipt by the candidate of the licensure examination results. C. The unlicensed graduate may reapply for a new traineeship while awaiting to take the next examination, provided he has registered to retake the examination. A new traineeship shall not be approved if more than one year has passed following the receipt of the first examination results. An unlicensed graduate who has passed the examination may be granted a new traineeship for the period between passage of the examination and granting of a license. An unlicensed graduate shall not be granted more than three traineeships within the one year following the receipt of the first examination results. 18VAC112-20-80. (Repealed.) --------------------------- 18VAC112-20-81. Requirements for direct access certification. ------------------------------------------------------------- A. An applicant for certification to provide services to patients without a referral as specified in § [[54.1-3482.1]](http://law.lis.virginia.gov/vacode/54.1-3482.1/) of the Code of Virginia shall hold an active, unrestricted license as a physical therapist in Virginia and shall submit evidence satisfactory to the board that he has one of the following qualifications: B. In addition to the evidence of qualification for certification required in subsection A of this section, an applicant seeking direct access certification shall submit to the board: 18VAC112-20-82. Requirements for a compact privilege. ----------------------------------------------------- To obtain a compact privilege to practice physical therapy in Virginia, a physical therapist or physical therapist assistant licensed in a remote state shall comply with the rules adopted by the Physical Therapy Compact Commission in effect at the time of application to the commission. Part III. Practice Requirements. ================================ 18VAC112-20-90. General responsibilities. ----------------------------------------- A. The physical therapist shall be responsible for managing all aspects of the physical therapy care of each patient and shall provide: B. The physical therapist shall communicate the overall plan of care to the patient or the patient\'s legally authorized representative and shall also communicate with a referring doctor of medicine, osteopathy, chiropractic, podiatry, or dental surgery; nurse practitioner; or physician assistant to the extent required by § [[54.1-3482]](http://law.lis.virginia.gov/vacode/54.1-3482/) of the Code of Virginia. C. A physical therapist assistant may assist the physical therapist in performing selected components of physical therapy intervention to include treatment, measurement, and data collection but not to include the performance of an evaluation as defined in [[18VAC112-20-10]](http://law.lis.virginia.gov/admincode/title18/agency112/chapter20/section10/). D. A physical therapist assistant\'s encounters with a patient may be made under general supervision. E. A physical therapist providing services with a direct access certification as specified in § [[54.1-3482]](http://law.lis.virginia.gov/vacode/54.1-3482/) of the Code of Virginia shall utilize the Direct Access Patient Attestation and Medical Release Form prescribed by the board or otherwise include in the patient record the information, attestation and written consent required by subsection B of § [[54.1-3482]](http://law.lis.virginia.gov/vacode/54.1-3482/) of the Code of Virginia. F. A physical therapist or physical therapist assistant practicing in Virginia on a compact privilege shall comply with all applicable laws and regulations pertaining to physical therapy practice in Virginia. 18VAC112-20-100. Supervisory responsibilities. ---------------------------------------------- A. A physical therapist shall be fully responsible for any action of persons performing physical therapy functions under the physical therapist\'s supervision or direction. B. Support personnel shall only perform routine assigned physical therapy tasks under the direct supervision of a licensed physical therapist or a licensed physical therapist assistant, who shall only assign those tasks or activities that are nondiscretionary and do not require the exercise of professional judgment. C. A physical therapist shall provide direct supervision to no more than three individual trainees or students at any one time. D. A physical therapist shall provide direct supervision to a student in an approved program who is satisfying clinical educational requirements in physical therapy. A physical therapist or a physical therapist assistant shall provide direct supervision to a student in an approved program for physical therapist assistants. E. A physical therapist shall provide direct supervision to a student who is satisfying clinical educational requirements in physical therapy in a nonapproved physical therapist program that has been granted the Candidate for Accreditation status from CAPTE. Either a physical therapist or physical therapist assistant shall provide direct supervision to a student who is satisfying clinical education requirements in a nonapproved physical therapist assistant program that has been granted the Candidate for Accreditation status from CAPTE. 18VAC112-20-110. (Repealed.) ---------------------------- 18VAC112-20-120. Responsibilities to patients. ---------------------------------------------- A. The initial patient encounter shall be made by the physical therapist for evaluation of the patient and establishment of a plan of care. B. The physical therapist assistant\'s first encounter with the patient shall only be made after verbal or written communication with the physical therapist regarding patient status and plan of care. Documentation of such communication shall be made in the patient\'s record. C. Documentation of physical therapy interventions shall be recorded on a patient\'s record by the physical therapist or physical therapist assistant providing the care. D. The physical therapist shall reevaluate the patient as needed, but not less than according to the following schedules: Failure to abide by this subsection due to the absence of the physical therapist in case of illness, vacation, or professional meeting for a period not to exceed five consecutive days will not constitute a violation of these provisions. E. The physical therapist shall be responsible for ongoing involvement in the care of the patient to include regular communication with a physical therapist assistant regarding the patient\'s plan of treatment. 18VAC112-20-121. Practice of dry needling. ------------------------------------------ A. Dry needling is an invasive procedure that requires referral and direction in accordance with § [[54.1-3482]](http://law.lis.virginia.gov/vacode/54.1-3482/) of the Code of Virginia. Referral should be in writing; if the initial referral is received orally, it shall be followed up with a written referral. B. Dry needling is not an entry level skill but an advanced procedure that requires additional post-graduate training. C. Prior to the performance of dry needling, the physical therapist shall obtain informed consent from the patient or the patient\'s representative. The informed consent shall include the risks and benefits of the technique. The informed consent form shall be maintained in the patient record. D. Dry needling shall only be performed by a physical therapist trained pursuant to subsection B of this section and shall not be delegated to a physical therapist assistant or other support personnel. Part IV. Renewal or Relicensure Requirements. ============================================= 18VAC112-20-130. Biennial renewal of license. --------------------------------------------- []{#_heading=h.3whwml4.anchor}A. A physical therapist or physical therapist assistant who intends to continue practice shall renew his license biennially by December 31 in each even-numbered year and pay to the board the renewal fee prescribed in [[18VAC112-20-27]](http://law.lis.virginia.gov/admincode/title18/agency112/chapter20/section27/). B. A licensee whose licensure has not been renewed by the first day of the month following the month in which renewal is required shall pay a late fee as prescribed in [[18VAC112-20-27]](http://law.lis.virginia.gov/admincode/title18/agency112/chapter20/section27/). C. In order to renew an active license, a licensee shall be required to: D. The board may grant an extension of the deadline for completing active practice requirements for up to one year for good cause shown upon a written request from the licensee prior to the renewal date. E. The board may grant an exemption to the active practice requirement for circumstances beyond the control of the licensee, such as temporary disability, mandatory military service, or officially declared disaster, upon a written request from the licensee prior to the renewal date. F. In order to renew a compact privilege to practice in Virginia, the holder shall comply with the rules adopted by the Physical Therapy Compact Commission in effect at the time of the renewal. 18VAC112-20-131. Continued competency requirements for renewal of an active license. ------------------------------------------------------------------------------------ A. In order to renew an active license biennially, a physical therapist or a physical therapist assistant shall complete at least 30 contact hours of continuing learning activities within the two years immediately preceding renewal. In choosing continuing learning activities or courses, the licensee shall consider the following: (i) the need to promote ethical practice, (ii) an appropriate standard of care, (iii) patient safety, (iv) application of new medical technology, (v) appropriate communication with patients, and (vi) knowledge of the changing health care system. B. To document the required hours, the licensee shall maintain the Continued Competency Activity and Assessment Form that is provided by the board and that shall indicate completion of the following: C. A licensee shall be exempt from the continuing competency requirements for the first biennial renewal following the date of initial licensure by examination in Virginia. D. The licensee shall retain his records on the completed form with all supporting documentation for a period of four years following the renewal of an active license. E. The licensees selected in a random audit conducted by the board shall provide the completed Continued Competency Activity and Assessment Form and all supporting documentation within 30 days of receiving notification of the audit. F. Failure to comply with these requirements may subject the licensee to disciplinary action by the board. G. The board may grant an extension of the deadline for continuing competency requirements for up to one year for good cause shown upon a written request from the licensee prior to the renewal date. H. The board may grant an exemption for all or part of the requirements for circumstances beyond the control of the licensee, such as temporary disability, mandatory military service, or officially declared disasters, upon a written request from the licensee prior to the renewal date. 18VAC112-20-135. Inactive license. ---------------------------------- A. A physical therapist or physical therapist assistant who holds a current, unrestricted license in Virginia shall, upon a request on the renewal application and submission of the required renewal fee, be issued an inactive license. B. A physical therapist or physical therapist assistant who holds an inactive license may reactivate his license by: 18VAC112-20-136. Reinstatement requirements. -------------------------------------------- A. A physical therapist or physical therapist assistant whose Virginia license is lapsed for two years or less may reinstate his license by payment of the renewal and late fees as set forth in [[18VAC112-20-27]](http://law.lis.virginia.gov/admincode/title18/agency112/chapter20/section27/) and completion of continued competency requirements as set forth in [[18VAC112-20-131]](http://law.lis.virginia.gov/admincode/title18/agency112/chapter20/section131/). B. A physical therapist or physical therapist assistant whose Virginia license is lapsed for more than two years and who is seeking reinstatement shall: 18VAC112-20-140. Traineeship requirements. ------------------------------------------ A. The traineeship shall be approved by the board and served under the direction and supervision of a licensed physical therapist. B. Supervision and identification of trainees: C. Completion of traineeship. D. A traineeship shall not be approved for an applicant who has not completed a criminal background check for initial licensure pursuant to § [[54.1-3484]](http://law.lis.virginia.gov/vacode/54.1-3484/) of the Code of Virginia*.* 18VAC112-20-150. (Repealed.) ---------------------------- 18VAC112-20-151. (Repealed.) ---------------------------- Part V. Standards of Practice. ============================== 18VAC112-20-160. Requirements for patient records. -------------------------------------------------- A. Practitioners shall comply with provisions of § [[32.1-127.1:03]](http://law.lis.virginia.gov/vacode/32.1-127.1:03/) of the Code of Virginia related to the confidentiality and disclosure of patient records. B. Practitioners shall provide patient records to another practitioner or to the patient or his personal representative in a timely manner in accordance with provisions of § [[32.1-127.1:03]](http://law.lis.virginia.gov/vacode/32.1-127.1:03/) of the Code of Virginia. C. Practitioners shall properly manage and keep timely, accurate, legible and complete patient records. D. Practitioners who are employed by a health care institution, school system or other entity, in which the individual practitioner does not own or maintain his own records, shall maintain patient records in accordance with the policies and procedures of the employing entity. E. Practitioners who are self-employed or employed by an entity in which the individual practitioner does own and is responsible for patient records shall: F. When a practitioner is closing, selling or relocating his practice, he shall meet the requirements of § [[54.1-2405]](http://law.lis.virginia.gov/vacode/54.1-2405/) of the Code of Virginia for giving notice that copies of records can be sent to any like-regulated provider of the patient\'s choice or provided to the patient. 18VAC112-20-170. Confidentiality and practitioner-patient communication. ------------------------------------------------------------------------ A. A practitioner shall not willfully or negligently breach the confidentiality between a practitioner and a patient. A breach of confidentiality that is required or permitted by applicable law or beyond the control of the practitioner shall not be considered negligent or willful. B. Communication with patients. C. Termination of the practitioner/patient relationship. 18VAC112-20-180. Practitioner responsibility. --------------------------------------------- A. A practitioner shall not: B. A practitioner shall not knowingly and willfully solicit or receive any remuneration, directly or indirectly, in return for referring an individual to a facility or institution as defined in § [[37.2-100]](http://law.lis.virginia.gov/vacode/37.2-100/) of the Code of Virginia, or hospital as defined in § [[32.1-123]](http://law.lis.virginia.gov/vacode/32.1-123/) of the Code of Virginia. Remuneration shall be defined as compensation, received in cash or in kind, but shall not include any payments, business arrangements, or payment practices allowed by 42 USC § 1320a-7b(b) \] or any regulations promulgated thereto. C. A practitioner shall not willfully refuse to provide information or records as requested or required by the board or its representative pursuant to an investigation or to the enforcement of a statute or regulation. D. A practitioner shall report any disciplinary action taken by a physical therapy regulatory board in another jurisdiction within 30 days of final action. 18VAC112-20-190. Sexual contact. -------------------------------- A. For purposes of § [[54.1-3483]](http://law.lis.virginia.gov/vacode/54.1-3483/) (10) of the Code of Virginia and this section, sexual contact includes, but is not limited to, sexual behavior or verbal or physical behavior that: B. Sexual contact with a patient. C. Sexual contact between a practitioner and a former patient. Sexual contact between a practitioner and a former patient after termination of the practitioner-patient relationship may still constitute unprofessional conduct if the sexual contact is a result of the exploitation of trust, knowledge, or influence of emotions derived from the professional relationship. D. Sexual contact between a practitioner and a key third party shall constitute unprofessional conduct if the sexual contact is a result of the exploitation of trust, knowledge or influence derived from the professional relationship or if the contact has had or is likely to have an adverse effect on patient care. For purposes of this section, key third party of a patient shall mean spouse or partner, parent or child, guardian, or legal representative of the patient. E. Sexual contact between a supervisor and a trainee shall constitute unprofessional conduct if the sexual contact is a result of the exploitation of trust, knowledge or influence derived from the professional relationship or if the contact has had or is likely to have an adverse effect on patient care. 18VAC112-20-200. Advertising ethics. ------------------------------------ A. Any statement specifying a fee, whether standard, discounted, or free, for professional services that does not include the cost of all related procedures, services, and products that, to a substantial likelihood, will be necessary for the completion of the advertised service as it would be understood by an ordinarily prudent person shall be deemed to be deceptive or misleading, or both. Where reasonable disclosure of all relevant variables and considerations is made, a statement of a range of prices for specifically described services shall not be deemed to be deceptive or misleading. B. Advertising a discounted or free service, examination, or treatment and charging for any additional service, examination, or treatment that is performed as a result of and within 72 hours of the initial office visit in response to such advertisement is unprofessional conduct unless such professional services rendered are as a result of a bona fide emergency. This provision may not be waived by agreement of the patient and the practitioner. C. Advertisements of discounts shall disclose the full fee that has been discounted. The practitioner shall maintain documented evidence to substantiate the discounted fees and shall make such information available to a consumer upon request. D. A licensee or holder of a compact privilege shall not use the term \"board certified\" or any similar words or phrase calculated to convey the same meaning in any advertising for his practice unless he holds certification in a clinical specialty issued by the American Board of Physical Therapy Specialties. E. A licensee or holder of a compact privilege of the board shall not advertise information that is false, misleading, or deceptive. For an advertisement for a single practitioner, it shall be presumed that the practitioner is responsible and accountable for the validity and truthfulness of its content. For an advertisement for a practice in which there is more than one practitioner, the name of the practitioner responsible and accountable for the content of the advertisement shall be documented and maintained by the practice for at least two years. F. Documentation, scientific and otherwise, supporting claims made in an advertisement shall be maintained and available for the board\'s review for at least two years.