regulations.pdf

STATE OF CALIFORNIA Gavin Newsom, Governor BOARD OF CHIROPRACTIC EXAMINERS Rules and Regulations Board of Chiropractic Examiners 1625 N. Market Blvd., Suite N-327...

STATE OF CALIFORNIA Gavin Newsom, Governor BOARD OF CHIROPRACTIC EXAMINERS Rules and Regulations Board of Chiropractic Examiners 1625 N. Market Blvd., Suite N-327 Sacramento, CA 95834 Revised November 2021 These regulations are contained in Title 16 of the California Code of Regulations, Division 4, beginning at Section 301. While every effort is made to assure that the information on this Web site is current, always refer to the California Code of Regulations to guarantee the most current information.  TABLE OF CONTENTS Page Article 1. General Provisions………………………………………………………..…….4 Section § 301. Tenses, Gender and Number. § 302. Practice of Chiropractic. §302.5. Use of Laser. § 303. Filing of Addresses. § 304. Discipline by Another State. § 305. Procedure in Disciplinary Proceedings. § 306. Delegation of Certain Functions. § 306.2. Person Not an Employee of the Board Hired to Provide Expertise to Board in Evaluation of Conduct of Licensee; Administration of a Board Examination; Non Liability of Board. § 306.3. Investigators; Authority to Inspect Premises. § 307. Refund of Fees. § 308. Display of License. Article 1.5 Sponsored Free Health Care Events – Requirements for Exemption…………7 Section § 309. Definitions. § 309.1. Sponsoring Entity Registration and Recordkeeping Requirements. § 309.2. Out-of-State Practitioner Authorization to Participate in Sponsored Event. § 309.3. Termination of Authorization and Appeal. § 309.4. Additional Practice Requirements for Out-of-State Practitioners. Authorized to Participate in Sponsored Free Health Care Events. Article 2. Practice of Chiropractic………………………………………………………..11 Section § 310. Change of Name. § 310.1. Replacement License. § 310.2. Use of the Title “Chiropractor” by Unlicensed Persons. § 311. Advertisements. §311.1. Chiropractic Specialties. § 312 Illegal Practice. § 312.1 Ownership of a Chiropractic Practice. § 312.2 Ownership of a Practice upon the Death or Incapacity of a Licensee. § 313. Inducing Student to Practice Chiropractic. § 314. Law Violators. § 315. Mental Illness. § 316. Responsibility for Conduct on Premises. § 316.5 Substantial Relationship Criteria. § 317. Unprofessional Conduct. § 317.1. Chiropractic Referral Services. § 317.5. Investigation and Enforcement Costs; Payment by Licentiate. § 318. Chiropractic Patient Records/Accountable Billings. 1  § 318.1. Standard of Care Regarding Manipulation Under Anesthesia (MUA). § 319. Free or Discount Services. § 319.1. Informed Consent. Article 3. Application for License to Practice Chiropractic……………………………..22 Section § 320. Temporary Permits or Licenses. § 321. Application for License. § 321.1. Fingerprint Submission. § 322. Age of Applicant. § 323. Reciprocity. Interpretation of Section 9 of the Act. § 325. Denial of License Application; Issuance of Probationary License §325.1. License Reapplication. §326. Rehabilitation Criteria for Denials, Reinstatements, and Reissuance of a License. §327 Rehabilitation Criteria for Suspensions or Revocations. Article 4. Approved School and Qualifications of Applicants…………………….…….25 Section § 330. Application for Approval. § 331.1. Approval and Eligibility. § 331.2. Inspection and Survey. § 331.3. Supervision. § 331.4. Financial Management. § 331.5. Records. § 331.6. Catalog. § 331.7. Calendar. § 331.8. Faculty. § 331.9. Student Faculty Ratio. § 331.10. Faculty Organization. § 331.11. Scholastic Regulations. § 331.12.1. Curriculum. § 331.12.2. Curriculum. § 331.12.3. Eligibility to Take Board Examination. § 331.13. Physical Facilities. § 331.14. Quality of Instruction. § 331.15. Violations or Failure to Comply. § 331.16. Definition of Board. Article 5. Examinations……………………………………………………………….…39 Section § 340. Examinations. § 341. Other Articles Forbidden. § 342. Conduct During Examination. § 343. Basis of Questions. § 344. Cheating. § 345. Retention of Papers. § 346. Interpretation of Part of Section 6(c) of the Act. § 348. Failure to Appear for Examination. § 349. Interpretation of Section 6(d) of the Act. 2  § 354. Successful Examination. Article 6. Continuing Education…………………………………………………...…….42 Section § 360. Continuing Education Fees. § 361. Continuing Education Requirements. § 362. Continuing Education Provider Approval, Duties and Responsibilities. § 363. Approval of Continuing Education Courses. § 363.1. Distance Learning Courses. § 364. Exemptions and Reduction of Requirement. § 365. Revoked Licenses. § 366. Continuing Education Audits. Article 7. Chiropractic Corporations…………………………………………………….51 Section § 367.1. Citation of Rules. § 367.2. Definitions. § 367.3. Professional Relationships, Responsibilities, and Conduct Not Affected. § 367.4. Office for Filing. § 367.5. Application, Review of Refusal to Approve. § 367.6. Requirements for Issuance of Certificate of Registration. § 367.7. Name of Corporation. § 367.8. Security for Claims Against a Chiropractic Corporation. § 367.9. Shares: Ownership and Transfer. § 367.10. Certificate of Registration; Continuing Validity; Reports. Article 7.5 License Renewal Requirements……………………………………………….54 Section §370. License Renewal Fees. §371. Annual License Renewals and Restoration. §372. Continued Jurisdiction of a License. Article 8. Conflict of Interest Code…………………………………………………..….56 § 375. General Provisions Appendix Article 9. Enforcement and Discipline…………………………………………….……..56 Section § 384. Disciplinary Guidelines. § 386. Fraud. § 389. Letter of Admonishment. § 390. Issuance of Citations § 390.1. Criteria to Be Considered. § 390.3. Citations for Unlicensed Practice. § 390.4. Contested Citations. § 390.5. Compliance with Citation/Order of Abatement. § 390.6 Notification to Other Boards and Agencies. 3  Article 1. General Provisions §301. Tenses, Gender and Number. For the purpose of the rules and regulations contained in this chapter, the present tense includes the past and future tenses, and the future, the present; the masculine gender includes the feminine, and the feminine, the masculine; and the singular includes the plural, and the plural, the singular. §302. Practice of Chiropractic. (a) Scope of Practice. (1) A duly licensed chiropractor may manipulate and adjust the spinal column and other joints of the human body and in the process thereof a chiropractor may manipulate the muscle and connective tissue related thereto. (2) As part of a course of chiropractic treatment, a duly licensed chiropractor may use all necessary mechanical, hygienic, and sanitary measures incident to the care of the body, including, but not limited to, air, cold, diet, exercise, heat, light, massage, physical culture, rest, ultrasound, water, and physical therapy techniques in the course of chiropractic manipulations and/or adjustments. (3) Other than as explicitly set forth in section 10(b) of the Act, a duly licensed chiropractor may treat any condition, disease, or injury in any patient, including a pregnant woman, and may diagnose, so long as such treatment or diagnosis is done in a manner consistent with chiropractic methods and techniques and so long as such methods and treatment do not constitute the practice of medicine by exceeding the legal scope of chiropractic practice as set forth in this section. (4) A chiropractic license issued in the State of California does not authorize the holder thereof: (A) to practice surgery or to sever or penetrate tissues of human beings, including, but not limited to severing the umbilical cord; (B) to deliver a human child or practice obstetrics; (C) to practice dentistry; (D) to practice optometry; (E) to use any drug or medicine included in materia medica; (F) to use a lithotripter; (G) to use ultrasound on a fetus for either diagnostic or treatment purposes; or (H) to perform a mammography. 4  (5) A duly licensed chiropractor may employ the use of vitamins, food supplements, foods for special dietary use, or proprietary medicines, if the above substances are also included in section 4057 of the Business and Professions Code, so long as such substances are not included in materia medica as defined in section 13 of the Business and Professions Code. The use of such substances by a licensed chiropractor in the treatment of illness or injury must be within the scope of the practice of chiropractic as defined in section 7 of the Act. (6) Except as specifically provided in section 302(a)(4), a duly licensed chiropractor may make use of X-ray and thermography equipment for the purposes of diagnosis but not for the purposes of treatment. A duly licensed chiropractor may make use of diagnostic ultrasound equipment for the purposes of neuromuscular skeletal diagnosis. (7) A duly licensed chiropractor may only practice or attempt to practice or hold himself or herself out as practicing a system of chiropractic. A duly licensed chiropractor may also advertise the use of the modalities authorized by this section as a part of a course of chiropractic treatment, but is not required to use all of the diagnostic and treatment modalities set forth in this section. A chiropractor may not hold himself or herself out as being licensed as anything other than a chiropractor or as holding any other healing arts license or as practicing physical therapy or use the term “physical therapy” in advertising unless he or she holds another such license. (b) Definitions. (1) Board. The term “board” means the State Board of Chiropractic Examiners. (2) Act. The term “act” means the Chiropractic Initiative Act of California as amended. NOTE: The Chiropractic Initiative Act of California is listed in West's Annotated California Codes following section 1000 of the Business and Professions Code, and in Deering's California Codes Annotated as an appendix to the Business and Professions Code. (3) Duly licensed chiropractor. The term “duly licensed chiropractor” means any chiropractor in the State of California holding an unrevoked certificate to practice chiropractic, as that term is defined in section 7 of the Act, that has been issued by the board. § 302.5. Use of Laser. (a) A duly licensed chiropractor and any person under their direct or indirect supervision, as defined in section 312, shall: (1) Not use any laser in the practice of chiropractic which has not been properly approved or cleared by the United States Food and Drug Administration (FDA). (2) Not market or advertise the use of a laser or use a laser for purposes other than treatment consistent with section 302 and the product’s FDA approval or clearance. (3) Follow the manufacturer’s specified guidelines for the safe use of laser. (4) Comply with all state and federal laws governing the use of lasers in clinical settings. 5 (b) Nothing in this section shall be construed to authorize the use of a laser by a chiropractor outside of the chiropractic scope of practice. This includes, but is not limited to, laser ablation or surgical procedures, and laser treatment of allergies. (c) Any violation of this section may constitute unprofessional conduct and the licensee shall be subject to discipline by the Board. §303. Filing of Addresses. Each person holding a license to practice chiropractic in the State of California under any and all laws administered by the board shall file his proper and current place of practice address of his principal office and, where appropriate, each and every sub-office, with the board at its office in Sacramento and shall immediately notify the board at its said office of any and all changes of place of practice address, giving both his old and his new address within 30 days of change. §304. Discipline by Another State. The revocation, suspension, or other discipline by another state of a license or certificate to practice chiropractic, or any other health care profession for which a license or certificate is required, shall constitute grounds for disciplinary action against a chiropractic licensee or grounds for the denial of chiropractic licensure of an applicant in this state. §305. Procedure in Disciplinary Proceedings. All proceedings relating to the refusal to grant, suspension or revocation of a license to practice chiropractic, or for the reissuance or reinstatement of a license which has been suspended or revoked, or for the disciplining of licensees in any manner, shall be conducted in accordance with the provisions of Section 11500 et seq. of Chapter 5 of Part 1 of Division 3 of Title 2 of the Government Code. §306. Delegation of Certain Functions. The power and discretion of the board to receive and file accusations; issue notices of hearing, statements to respondent, statements of issues, subpoenas, and subpoenas duces tecum; receive and file notices of defense; set and calendar cases for hearing; certify and deliver or mail copies of decisions; and perform other functions necessary to expedite the business of the board in connection with the conduct of the proceedings mentioned in Section 305 hereof in accordance with the provisions of Chapter 5 of Part 1 of Division 3 of Title 2 of the Government Code, are hereby delegated to the Executive Officer. §306.2. Persons Not Employees Hired Under Contract with the Board. If a person, not a regular employee of the board, is hired or is under contract to provide expertise or to perform investigations for the Board of Chiropractic Examiners in the evaluation of the conduct of a licensee or administration of a board examination, and such person is named as a defendant in a civil action directly resulting from opinions rendered, statements made, investigations conducted or testimony given, the board shall provide for representation required to defend the defendant in that civil action. The board shall not be liable for any judgment rendered against that person. The Attorney General shall be utilized in those civil actions. 6 §306.3. Investigators; Authority to Inspect Premises. The board or its designee may inspect the physical premises of any chiropractic office during regular business hours. §307. Refund of Fees. The board is not authorized or permitted by law to return any portion of the license application fee of a qualified applicant. §308. Display of License. (a) Each person holding a license shall display a current active license in a conspicuous place in the licensee’s principal office or primary place of practice. (b) Any licensed Doctor of Chiropractic with more than one place of practice shall obtain from the Board a Satellite Office Certificate for each additional place of practice. Said certificate must be renewed annually. (c) A licensed Doctor of Chiropractic must display in a conspicuous place a current active Satellite Office Certificate at the office for which it was issued. No licensed Doctor of Chiropractic shall display any chiropractic license, certificate or registration, which is not currently active and valid. Article 1.5. Sponsored Free Health Care Events §309. Definitions. For the purposes of section 901 of the Business and Professions Code: (a) “Community-based organization” means a public or private nonprofit organization that is representative of a community or a significant segment of a community, and is engaged in meeting human, educational, environmental, or public safety community needs. (b) “Out-of-state practitioner” means a person who is not licensed in California to engage in the practice of chiropractic but who holds a current, active and valid license in good standing in another state, district, or territory of the United States to practice chiropractic. (c) The term “in good standing” means that a person: (1) Is not currently the subject of any investigation by any governmental entity or has not been charged with an offense for any act substantially related to the practice of chiropractic by any public agency; (2) Has not entered into any consent agreement or been subject to an administrative decision that contains conditions placed by an agency upon the person's professional conduct or practice of chiropractic, including any voluntary surrender of license; or, 7  (3) Has not been the subject of an adverse judgment resulting from the practice of chiropractic that the board determines constitutes evidence of a pattern of incompetence or negligence. §309.1 Sponsoring Entity Registration and Recordkeeping Requirements. (a) Registration. A sponsoring entity that wishes to provide, or arrange for the provision of, health care services at a sponsored event under section 901 of the Business and Professions Code shall register with the board not later than 90 calendar days prior to the date on which the sponsored event is scheduled to begin. A sponsoring entity shall register with the board, or its delegatee, by submitting to the board a completed “Registration of Sponsoring Entity Under Business & Professions Code Section 901”, Form 901-A (DCA/2014 - revised), which is hereby incorporated by reference. (b) Determination of Completeness of Form. The board may, by resolution, delegate to the Department of Consumer Affairs the authority to receive and process “Registration of Sponsoring Entity Under Business and Professions Code Section 901”, Form 901-A (DCA/2014 - revised) on behalf of the board. The board, or its delegatee, shall inform the sponsoring entity within 15 calendar days of receipt of Form 901-A (DCA/2014 - revised) in writing that the form is either complete and the sponsoring entity is registered or that the form is deficient and what specific information or documentation is required to complete the form and be registered. The board, or its delegatee, shall reject the registration if all of the identified deficiencies have not been corrected at least 30 days prior to the commencement of the sponsored event. (c) Recordkeeping Requirements. Regardless of where it is located, a sponsoring entity shall maintain at a physical location in California a copy of all records required by Business and Professions Code section 901 as well as a copy of the authorization for participation issued by the board to an out-of-state practitioner. The sponsoring entity shall maintain these records for a period of at least 5 years after the date on which a sponsored event ended. The records may be maintained in either paper or electronic form. The sponsoring entity shall notify the board at the time of registration as to the form in which it will maintain the records. In addition, the sponsoring entity shall keep a copy of all records required by section 901(g) of the Business and Professions Code at the physical location of the sponsored event until that event has ended. These records shall be available for inspection and copying during the operating hours of the sponsored event upon request of any representative of the board. In addition, the sponsoring entity shall provide copies of any record required to be maintained by section 901 of the Business and Professions Code to any representative of the board within 15 calendar days of the request. (d) Requirement for Prior Board Approval of Out-of-State Practitioner. A sponsoring entity shall not permit an out-of-state practitioner to participate in a sponsored event unless and until the sponsoring entity has received written approval of such practitioner from the board. (e) Report. Within 15 calendar days after a sponsored event has concluded, the sponsoring entity shall file a report with the board summarizing the details of the sponsored event. This report may be in a form of the sponsoring entity's choosing, but shall include, at a minimum, the following information: 8  (1) The date(s) of the sponsored event; (2) The location(s) of the sponsored event; (3) The type(s) and general description of all health care services provided at the sponsored event; and (4) A list of each out-of-state practitioner granted authorization pursuant to this article who participated in the sponsored event, along with the license number of that practitioner. § 309.2. Out-of-State Practitioner Authorization to Participate in Sponsored Event. (a) Request for Authorization to Participate. An out-of-state practitioner (“applicant”) may request authorization from the board to participate in a sponsored event and provide such health care services at the sponsored event as would be permitted if the applicant were licensed by the board to provide those services. Authorization shall be obtained for each sponsored event in which the applicant seeks to participate. (1) An applicant shall request authorization by submitting to the board a completed “Request for Authorization to Practice Without a License at a Registered Free Health Care Event”, Form 901-B (BCE/2015), which is hereby incorporated by reference, accompanied by a non- refundable processing fee of $59.00. (2) The applicant shall also furnish either a full set of fingerprints or submit a Live Scan inquiry to establish the identity of the applicant and to permit the board to conduct a criminal history record check. The applicant shall pay any costs for furnishing the fingerprints and conducting the criminal history record check. This requirement shall apply only to the first application for authorization that is submitted to the board by the applicant. (b) Response to Request for Authorization to Participate. Within 20 calendar days of receiving a completed request for authorization, the board shall notify the sponsoring entity and the applicant whether that request is approved or denied. (c) Denial of Request for Authorization to Participate. (1) The board shall deny a request for authorization to participate if: (A) The submitted Form 901-B (BCE/2015) is incomplete and the applicant has not responded within 7 calendar days to the board's request for additional information; (B) The applicant does not possess a current, active and valid license in good standing; (C) The applicant has failed to comply with a requirement of this article or has committed any act that would constitute grounds for denial under section 480 of the Business and Professions Code of an application for licensure by the board; (D) The applicant has a current physical or mental impairment related to drugs or alcohol; 9  (E) The applicant has not graduated from a chiropractic college approved or recognized by the board; or (F) The board has been unable to obtain a timely report of the results of the criminal history check. (2) The board may deny a request for authorization to participate if: (A) The request is received less than 20 calendar days before the date on which the sponsored event will begin; (B) The applicant has been previously denied a request for authorization by the board to participate in a sponsored event; or (C) The applicant has previously had an authorization to participate in a sponsored event terminated by the board. (d) Appeal of Denial. An applicant requesting authorization to participate in a sponsored event may appeal the denial of such request by following the procedures set forth in Business and Professions Code section 309.3(d). § 309.3. Termination of Authorization and Appeal. (a) Grounds for Termination. The board may terminate an out-of-state practitioner's authorization to participate in a sponsored event for any of the following reasons: (1) The out-of-state practitioner has failed to comply with any applicable provision of this article, or any applicable practice requirement or regulation of the board. (2) The out-of-state practitioner has committed an act that would constitute grounds for discipline if done by a licensee of the board. (3) The board has received a credible complaint indicating that the out-of-state practitioner is unfit to practice at the sponsored event or has otherwise endangered consumers of the practitioner's services. (b) Notice of Termination. The board shall provide both the sponsoring entity and the out-of- state practitioner with a written notice of the termination, including the basis for the termination. If the written notice is provided during a sponsored event, the board may provide the notice to any representative of the sponsored event on the premises of the event. (c) Consequences of Termination. An out-of-state practitioner shall immediately cease his or her participation in a sponsored event upon receipt of the written notice of termination. Termination of authority to participate in a sponsored event shall be deemed a disciplinary measure reportable to the national practitioner data banks. In addition, the board shall provide a copy of the written notice of termination to the licensing authority of each jurisdiction in which the out-of-state practitioner is licensed. 10  (d) Appeal of Termination. An out-of-state practitioner may appeal the board's decision to terminate an authorization in the manner provided by section 901(j)(2) of the Business and Professions Code. The request for an appeal shall be considered a request for an informal hearing under the Administrative Procedure Act (commencing with section 11445.10 of the Government Code). (e) Informal Conference Option. In addition to requesting a hearing, the out-of-state practitioner may request an informal conference with the Executive Officer regarding the reasons for the termination of authorization to participate. The Executive Officer shall, within 30 days from receipt of the request, hold an informal conference with the out-of-state practitioner. At the conclusion of the informal conference, the Executive Officer may affirm or dismiss the termination of authorization to participate. The Executive Officer shall state in writing the reasons for his or her action and mail a copy of his or her findings and decision to the out-of- state practitioner within 10 (ten) days from the date of the informal conference. The out-of-state practitioner does not waive his or her request for a hearing to contest a termination of authorization by requesting an informal conference. If the termination is dismissed after the informal conference, the request for a hearing shall be deemed to be withdrawn. § 309.4. Additional Practice Requirements for Out-of-State Practitioners Authorized to Participate in Sponsored Free Health Care Events. (a) Each out-of-state practitioner authorized to participate in a sponsored event and provide chiropractic services at the sponsored event pursuant to Section 309.2 shall post a notice visible to patients or prospective patients at every station that patients will be seen. This notice shall be in at least 48 point Arial font and include the following information: NOTICE I hold a current valid license to practice chiropractic in a state other than California. I have been authorized by the California Board of Chiropractic Examiners to provide chiropractic services in California only at this specific health fair. California Board of Chiropractic Examiners (800) 735-2929 www.chiro.ca.gov Article 2. Practice of Chiropractic §310. Change of Name. Any licensee who shall change his name according to the law, shall, within 10 days of such change, reregister his name with the Executive Officer of the board by submitting to the board office a written statement of the change and evidence of legal documentation. §310.1. Replacement License. Any licensee shall be entitled to a replacement license if his original license is lost, stolen or mangled, or upon written request and legal documentation of name change. Each request for a replacement license must be accompanied by a nonrefundable fee of $25.00, and signed written 11 statement as to the circumstances of loss of said license, or the return to the board office of the mangled license. §310.2. Use of Title by Unlicensed Persons. No person shall engage in the practice of chiropractic, as defined in Section 302, without holding a license which is in an active status, issued by the Board. Any person who advertises or promotes, in any manner, the words “doctor” or “chiropractor”, the letters, prefixes or suffixes “Dr.” or “D.C.”, or any other word, title or letters indicating or implying that he or she is engaged in the practice of chiropractic, or who represents or holds himself or herself out as a doctor of chiropractic without having, at the time of so doing, a valid, unrevoked, or unsurrendered license, is in violation of the Chiropractic Initiative Act. §311. Advertisements. Constructive educational publicity is encouraged, but the use by any licensee of advertising which contains misstatements, falsehoods, misrepresentations, distorted, sensational or fabulous statements, or which is intended or has a tendency to deceive the public or impose upon credulous or ignorant persons, constitutes grounds for the imposition of any of the following disciplinary penalties: (a) Suspension of said licensee's right to practice in this State for a period not exceeding one (1) year. (b) Placing said licensee upon probation. (c) Taking such other action, excepting the revocation of said licensee's license, in relation to disciplining said licensee as the board in its discretion may deem proper. §311.1. Chiropractic Specialties. For purposes of the Department of Industrial Relations’ Qualified Medical Evaluator Eligibility regulations (Division of Workers’ Compensation, Title 8, California Code of Regulations, Section 12), the board recognizes only those specialty boards that are recognized by the American Chiropractic Association or the International Chiropractors Association. §312. Illegal Practice. Unlicensed individuals are not permitted to diagnose, analyze, or perform a chiropractic adjustment. An “unlicensed individual” is defined as any person, including a student or graduate of a chiropractic institution, who does not hold a valid California chiropractic license. An exemption is hereby created for student doctors participating in board approved preceptorship programs. The permitted activities of unlicensed individuals are as follows: (a) Unlicensed individuals may take the history of a patient. However, this activity is separate from the consultation which at all times must be conducted by the licensed doctor. (b) Unlicensed individuals may conduct standard neurological, orthopedic, physical and chiropractic examinations, except they may not perform such examinations which require 12 diagnostic or analytic interpretations nor may they render a conclusion either verbally or in writing regarding the patient's physical condition. As an example, unlicensed individuals may not perform evaluations of heart or lung soundings. Such individuals shall be at all times under the immediate and direct supervision of a licensed Doctor of Chiropractic. “Immediate and direct supervision” means the licensed Doctor of Chiropractic shall be at all times on the premises where the examinations are being conducted. The licensed Doctor of Chiropractic shall be responsible for the verification of the recorded findings and will be solely responsible for rendering a conclusion based on the findings. (c) Unlicensed individuals may administer physical therapy treatments as an adjunct to chiropractic adjustment, provided the physical therapy treatment is conducted under the adequate supervision of a licensed Doctor of Chiropractic. Adequate supervision shall include all of the following: (1) The doctor shall be present in the same chiropractic facility with the unlicensed individual at least fifty percent of any work week or portion thereof the said individual is on duty unless this requirement has been waived by the board. The doctor shall be readily available to the said individual at all other times for advice, assistance and instruction. (2) The doctor shall initially examine and prepare a written treatment program for a patient prior to the providing of physical therapy treatment by the unlicensed individual. (3) The doctor shall provide periodic reevaluation of the treatment program and of the individual's performance in relation to the patient. “Periodic reevaluation” shall mean at least once every thirty days the patient is under active care. (4) The doctor shall perform and record an evaluation of the patient and his or her response to treatment at the termination thereof. (d) Unlicensed individuals may mark X-ray films administered by a Doctor of Chiropractic. “Marking X-rays” is defined as drawing and measuring between reference points and making angular and linear measurements. Unlicensed individuals are not permitted to make any diagnostic conclusions or chiropractic analytical listings, and the licensed doctor is responsible for any pathological entities covered or obstructed by the markings. (e) Unlicensed individuals may not administer X-rays unless they hold a valid X-ray technician certificate from the Department of Health Services, or participate under the direct supervision of a licensed Doctor of Chiropractic in a training program approved by that department and set forth in Section 25668.1 of the California Health and Safety Code. This prohibition, set forth in Section 30403 of Title 17 of the California Administrative Code includes the following activities: (1) Positioning of patient; (2) Setting up of X-ray machines; (3) Pushing a button; 13  (4) Developing of films. The Department of Health Services has determined that unlicensed individuals may develop X-ray film if that is their sole radiologic responsibility. Unlicensed individuals who exceed the permitted scope of practice set forth in this regulation shall be in violation of Section 15 of the Chiropractic Act and shall be prohibited from applying for a California chiropractic license for such time as may be determined by the board. Student doctors participating in board approved preceptorship programs are not to be considered “unlicensed individuals” when working in said program. §312.1. Ownership of a Chiropractic Practice. No unlicensed individual may own a chiropractic practice regardless of the form in which the practice is established (individual ownership, partnership, corporation, etc.). This does not preclude a layperson from owning the facilities in which the practice is conducted, and the equipment provided. It does prohibit a layperson from being in a position of making and/or influencing decisions relating to diagnosis, or treatment of patients which are matters requiring chiropractic licensure. §312.2. Ownership of Practice upon the Death or Incapacity of a Licensee. In the event of the death of a chiropractic licensee, or the legal declaration of the mental incompetency of the licensee to practice, the unlicensed heirs or trustees of the chiropractor must dispose of the practice within six (6) months. At all times during that period the practice must be supervised by a licensed chiropractor. The board will consider a petition to extend this period if it is submitted within four (4) months after the death or the declaration of incompetence of the licensee, including identification of any extenuating circumstances that will prevent compliance. §313. Inducing Student to Practice Chiropractic. No licensee of chiropractic in the State of California shall offer or cause to be offered to a student or prospective student of chiropractic any promise or inducement, either written or verbal, which may induce said student or prospective student to believe he or she, during the freshman, sophomore, junior or senior years, or within the time that he or she shall be a student in, and/or before graduation from chiropractic school or college, and/or before receiving a license from the board, may be legally employed in any chiropractic private office, or chiropractic school or college, to practice chiropractic, with or without compensation, and no student shall accept or rely upon any such promise or understanding except that junior or senior students only may, for professional instruction, be assigned to regular clinic practice, during regular clinic hours, in the clinic conducted upon the premises of a regularly incorporated chiropractic school or college, and then only when said clinic is in charge of a duly licensed chiropractor as clinic instructor. This section does not apply to students and doctors who participate in preceptorship programs sponsored by chiropractic institutions holding status with the Council on Chiropractic Education or seeking such status. Violation of this rule by any student shall be deemed to be also a violation of Section 312 hereof. §314. Law Violators. It shall be the duty of every licensee to notify the Executive Officer or his or her designee of any violation of the act, or of these rules and regulations, in order that the board may take appropriate disciplinary action. 14 §315. Mental Illness. (a) Administrative Adjudication. The proceedings under this regulation shall be conducted in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code, and the board shall have all the powers granted therein. (b) Psychiatric Examinations. When reasonable cause exists that a person holding a license under this Act is mentally ill to the extent that it may affect his ability to conduct with safety to the public the practice authorized by such license, the board may order the license holder to be examined by one or more physicians specializing in psychiatry designated by the board. The report of such persons shall be made available to the license holder and may be received as direct evidence in a proceeding conducted pursuant to subsection (c) of this regulation. (c) Probation, Suspension, etc., in Event of Mental Illness; Reinstatement. If a license holder has been found to be mentally ill by one or more physicians specializing in psychiatry designated by the board, the results of which indicates that such illness does effect his ability to conduct, with safety, the practice authorized by his license, the board may take action, in accordance with subdivision (a) of this regulation, by any one of the following methods: (1) Placing him on probation. (2) Suspending his right to practice for a period not exceeding one year. (3) Revoking his license. (4) Taking such other action in relation to his license as the board in its discretion deems proper. The board shall not restore such license to good standing until it shall receive competent evidence, from one or more physicians specializing in psychiatry, designated by the board, of the absence or control of the condition which caused its action and until it is satisfied that with due regard to the public interest the licensee's right to practice may be safely reinstated. Before reinstating such a person, the board may require the person to pass an oral or written examination, or both, to determine his present fitness to resume his practice. (d) Conditions of Reinstatement. In setting aside action taken under subsection (c) of this regulation, the board may impose terms and conditions to be followed by the license holder after his license has been reinstated. The authority of the board to impose terms and conditions includes, but is not limited to, the following: (1) Requiring the license holder to obtain additional professional training and to pass an examination upon the completion of the training. The examination may be written or oral, or both, and may be a practical or clinical examination, or both, at the option of the board. (2) Requiring the license holder to submit to a complete diagnostic examination by one or more physicians appointed by the board. If the board requires the certificate holder to submit to such an examination, the board shall receive and consider any other report of a complete diagnostic examination given by one or more physicians of the license holder's choice. (3) Setting any other requirement the board in its discretion deems proper. 15 §316. Responsibility for Conduct on Premises. (a) Every licensee is responsible for the conduct of employees or other persons subject to his supervision in his place of practice, and shall insure that all such conduct in his place of practice conforms to the law and to the regulations herein. (b) Where a chiropractic license is used in connection with any premises, structure or facility, no sexual acts or erotic behavior involving patients, patrons or customers, including, but not necessarily limited to, sexual stimulation, masturbation or prostitution, shall be permitted on said premises, structure or facility. (c) The commission of any act of sexual abuse, sexual misconduct, or sexual relations by a licensee with a patient, client, customer or employee is unprofessional conduct and cause for disciplinary action. This conduct is substantially related to the qualifications, functions, or duties of a chiropractic license. This section shall not apply to sexual contact between a licensed chiropractor and his or her spouse or person in an equivalent domestic relationship when that chiropractor provides professional treatment. § 316.5 Substantial Relationship Criteria. (a) For the purposes of the denial, suspension or revocation of a license pursuant to Section 141 of the Business and Professions Code, Division 1.5 (commencing with Section 475) of the Business and Professions Code, or a violation of Section 10(b) of the Chiropractic Initiative Act of California, a crime, professional misconduct, or act shall be considered substantially related to the qualifications, functions or duties of a licensee, if, to a substantial degree, it evidences present or potential unfitness of a person holding a license to perform the functions authorized by the license in a manner consistent with the public health, safety or welfare. (b) In making the substantial relationship determination required under subdivision (a) for a crime, the Board shall consider all of the following criteria: (1) The nature and gravity of the offense. (2) The number of years elapsed since the date of the offense. (3) The nature and duties of a chiropractor. (c) For purposes of subdivision (a), a substantially related crime, professional misconduct, or act shall include, but is not limited to, the following: (1) Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate any provision or term of the Chiropractic Initiative Act of California, these regulations and/or other state or federal laws governing the practice of chiropractic. 16  (2) Conviction of a crime or act of child abuse, as defined in Sections 270 through 273.75 of the Penal Code, or dependent adult or elder abuse. (3) A conviction requiring a person to register as a sex offender pursuant to Section 290 of the Penal Code. (4) Any crime, professional misconduct, or act involving the sale, gift, administration, or furnishing of narcotics or dangerous drugs or dangerous devices, as defined in Section 4022 of the Business and Professions Code. (5) Conviction for assault, battery or other violence including, but not limited to, those violations listed in subdivision (d) of Section 11160 of the Penal Code. (6) Conviction of a crime involving lewd conduct or sexual impropriety, as defined in Section 726 of the Business and Professions Code. (7) Conviction of a crime or act involving fiscal dishonesty, theft, fraud or deceit. (8) Conviction or act involving the use of drugs or alcohol to an extent or in a manner dangerous to the individual or the public. §317. Unprofessional Conduct. The board shall take action against any holder of a license who is guilty of unprofessional conduct which has been brought to its attention, or whose license has been procured by fraud or misrepresentation or issued by mistake. Unprofessional conduct includes, but is not limited to, the following: (a) Gross negligence; (b) Repeated negligent acts; (c) Incompetence; (d) The administration of treatment or the use of diagnostic procedures which are clearly excessive as determined by the customary practice and standards of the local community of licensees; (e) Any conduct which has endangered or is likely to endanger the health, welfare, or safety of the public; (f) The administering to oneself, of any controlled substance, or the use of any dangerous drug or of alcoholic beverages to the extent or in a manner as to be dangerous or injurious to oneself, or to any other person or to the public, or to the extent that the use impairs the ability of the person to conduct with safety to the public the practice authorized by the license; (g) Conviction of a crime which is substantially related to the qualifications, functions or duties of a chiropractor; 17  (h) Conviction of any offense, whether felony or misdemeanor, involving moral turpitude, dishonesty, physical violence or corruption. The board may inquire into the circumstances surrounding the commission of the crime in order to fix the degree of discipline or to determine if such conviction was of an offense involving moral turpitude, dishonesty, physical violence or corruption. A plea or verdict of guilty, or a plea of nolo contendere is deemed to be a conviction within the meaning of the board's disciplinary provisions, irrespective of a subsequent order under the provisions of Section 1203.4 of the Penal Code. The board may order a license to be suspended or revoked, or may decline to issue a license upon the entering of a conviction or judgement in a criminal matter. (i) The conviction of more than one misdemeanor or any felony involving the use, consumption, or self-administration of any dangerous drug or alcoholic beverage, or any combination of those substances. (j) The violation of any of the provisions of law regulating the dispensing or administration of narcotics, dangerous drugs, or controlled substances; (k) The commission of any act involving moral turpitude, dishonesty, or corruption, whether the act is committed in the course of the individual's activities as a license holder, or otherwise; (l) Knowingly making or signing any certificate or other document relating to the practice of chiropractic which falsely represents the existence or nonexistence of a state of facts; (m) Violating or attempting to violate, directly or indirectly, or assisting in or abetting in the violation of, or conspiring to violate any provision or term of the Act or the regulations adopted by the board thereunder; (n) Making or giving any false statement or information in connection with the application for issuance of a license; (o) Impersonating an applicant or acting as a proxy for an applicant in any examination required by the board for the issuance of a license or certificate; (p) The use of advertising relating to chiropractic which violates section 17500 of the Business and Professions Code; (q) The participation in any act of fraud or misrepresentation; (r) Except as may be required by law, the unauthorized disclosure of any information about a patient revealed or discovered during the course of examination or treatment; (s) The employment or use of persons known as cappers or steerers to obtain business; (t) The offering, delivering, receiving or accepting of any rebate, refund, commission, preference, patronage, dividend, discount or other consideration as compensation or inducement for referring patients to any person; (u) Participation in information or referral bureaus which do not comply with section 317.1 of the regulations; 18  (v) Entering into an agreement to waive, abrogate, or rebate the deductible and/or co-payment amounts of any insurance policy by forgiving any or all of any patient's obligation for payment thereunder, when used as an advertising and/or marketing procedure, unless the insurer is notified in writing of the fact of such waiver, abrogation, rebate, or forgiveness in each such instance. In all insurance billings where a waiver of a deductible or a co-payment is intended as an advertising and/or marketing procedure, the chiropractor's statement and insurance billing shall contain the following statement: I/WE WAIVE CO-PAYMENT AND/OR DEDUCTIBLES. IT IS MY/OUR INTENTION TO DO THE FOLLOWING: (Indicate one choice below) ( ) BILL THE PATIENT $__________AFTER RECEIPT FROM YOU OF $___________. ( ) WAIVE ANY FURTHER PAYMENT FROM THE PATIENT AFTER RECEIPT FROM YOU OF $__________. ( ) IN CASES WHERE PREDETERMINATION OF INSURANCE BENEFITS IS NOT POSSIBLE, I/WE PROVIDE THE FOLLOWING WRITTEN EXPLANATION OF MY/OUR BILLING INTENTIONS: ______________________________________________________ ____________________________________________________________________________ (w) Not referring a patient to a physician and surgeon or other licensed health care provider who can provide the appropriate management of a patient's physical or mental condition, disease or injury within his or her scope of practice, if in the course of a diagnostic evaluation a chiropractor detects an abnormality that indicates that the patient has a physical or mental condition, disease, or injury that is not subject to appropriate management by chiropractic methods and techniques. This subsection shall not apply where the patient states that he or she is already under the care of such other physician and surgeon or other licensed health care provider who is providing the appropriate management for that physical or mental condition, disease, or injury within his or her scope of practice. (x) The offer, advertisement, or substitution of a spinal manipulation for vaccination. (y) [Reserved] (z).[Reserved] §317.1. Chiropractic Referral Services. Chiropractic referral services shall conform to the following: (1) A referral bureau shall be made up of at least five doctors, each of whom does not have fiduciary relationship one to the other, with one participating office representing no more than 20 percent of the bureau's available practitioners. The board will consider any extenuating circumstances which will prevent a service from complying with these requirements; (2) An application shall be filed with the board office which has been approved by the board, and properly identifies the service, structure and members; 19  (a) A nonrefundable application fee of $25.00 shall be submitted with the referral service application. (3) A telephone number shall be for a separate answering service; (4) The answering service of the bureau shall refer the caller to the next doctor on the list on a rotating basis. The following are exceptions: (a) A request for a specialist; (b) Geographic considerations; (c) Request for services in a language other than English. (5) Records on each referral shall be kept and include the following: (a) Date of referral; (b) Name and address of patient; (c) Name and address of doctor referred to. (6) When a 24-hour emergency referral service is offered, a member of the group shall be available. §317.5. Investigation and Enforcement Costs; Payment by Licentiate. (a) In any order in resolution of a disciplinary proceeding before the Board of Chiropractic Examiners, the board may request the administrative law judge to direct a licentiate found to have committed a volition or violations of the Chiropractic Initiative Act to pay a sum not to exceed the reasonable costs of the investigation and enforcement of the case. (b) A certified copy of the actual costs, or a good faith estimate of costs where actual costs are not available, signed by the board bringing the proceeding or its designated representative shall be prima facie evidence of reasonable costs of investigation and prosecution of the case. The costs shall include the amount of investigative and enforcement costs up to the date of the hearing, including, but not limited to, charges imposed by the Attorney General. (c) The administrative law judge shall make a proposed finding of the amount of reasonable costs of investigation and prosecution of the case when requested pursuant to subdivision (a). The board may reduce or eliminate the cost award, or remand to the administrative law judge where the proposed decision fails to make a finding on costs requested pursuant to subdivision (a). (d) Where an order for recovery of costs is made and timely payment is not made as directed in the board's decision, the board may enforce the order for repayment in any appropriate court. This right of enforcement shall be in addition to any other rights the board may have as to any licentiate to pay costs. 20  (e) In any action for recovery of costs, proof of the board's decision shall be conclusive proof of the validity of the order of payment and the terms for payment. (f)(1) Except as provided in paragraph (2), the board shall not renew or reinstate any license of any licentiate who has failed to pay all of the costs ordered under this section. (2) Notwithstanding paragraph (1), the board may, in its discretion, conditionally renew or reinstate for a maximum of one year the license of any licentiate who demonstrates financial hardship and who enters into a formal agreement with the board to reimburse the board within that one-year period for the unpaid costs. (g) All costs recovered under this section shall be considered a reimbursement for costs incurred and shall be deposited in the fund of the board recovering the costs. (h) Nothing in this section shall preclude the board from including the recovery of the costs of investigation and enforcement of a case in any stipulated settlement. §318. Chiropractic Patient Records/Accountable Billings. (a) Chiropractic Patient Records. Each licensed chiropractor is required to maintain all active and inactive chiropractic patient records for five years from the date of the doctor's last treatment of the patient unless state or federal laws require a longer period of retention. Active chiropractic records are all chiropractic records of patients treated within the last 12 months. Chiropractic patient records shall be classified as inactive when there has elapsed a period of more than 12 months since the date of the last patient treatment. All chiropractic patient records shall be available to any representative of the Board upon presentation of patient's written consent or a valid legal order. Active chiropractic patient records shall be immediately available to any representative of the Board at the chiropractic office where the patient has been or is being treated. Inactive chiropractic patient records shall be available upon ten days notice to any representative of the Board. The location of said inactive records shall be reported immediately upon request. Active and inactive chiropractic patient records must include all of the following: (1) Patient's full name, date of birth, and social security number (if available); (2) Patient gender, height and weight. An estimated height and weight is acceptable where the physical condition of the patient prevents actual measurement; (3) Patient history, complaint, diagnosis/analysis, and treatment must be signed by the primary treating doctor. Thereafter, any treatment rendered by any other doctor must be signed or initialed by said doctor; (4) Signature of patient; (5) Date of each and every patient visit; (6) All chiropractic X-rays, or evidence of the transfer of said X-rays; (7) Signed written informed consent as specified in Section 319.1. 21  (b) Accountable Billings. Each licensed chiropractor is required to ensure accurate billing of his or her chiropractic services whether or not such chiropractor is an employee of any business entity, whether corporate or individual, and whether or not billing for such services is accomplished by an individual or business entity other than the licensee. In the event an error occurs which results in an overbilling, the licensee must promptly make reimbursement of the overbilling whether or not the licensee is in any way compensated for such reimbursement by his employer, agent or any other individual or business entity responsible for such error. Failure by the licensee, within 30 days after discovery or notification of an error which resulted in an overbilling, to make full reimbursement constitutes unprofessional conduct. §318.1. Standard of Care Regarding Manipulation Under Anesthesia (MUA). (a) Manipulation Under Anesthesia (MUA) may only be performed in either: (1) A hospital that is licensed by the California Department of Public Health Licensing and Certification Program; or (2) An ambulatory surgery center that is licensed by the California Department of Public Health Licensing and Certification Program and that is either: (A) Operating pursuant to section 1248.1 of the Health and Safety Code or (B) Accredited by an agency approved by the Medical Board of California pursuant to Chapter 1.3 of Division 2 of the Health and Safety Code (commencing with section 1248). (b) Notwithstanding subsection (a), above, MUA shall not be performed in a mobile van as defined in subdivision (h) of section 1248.1 of the Health and Safety Code. (c) MUA may only be performed if the patient is administered anesthesia by a California licensed physician and surgeon or other health care provider authorized under California law to administer anesthesia. (d) MUA may only be performed following an appropriate prior examination of the patient by a California licensed physician and surgeon. (e) The chiropractor may not direct, instruct, interfere, or make any orders to the physician and surgeon or other health care provider who is administering and maintaining the anesthesia. (f) MUA shall be performed by two licensed and competent chiropractors. The “primary chiropractor” shall formulate the chiropractic portion of the MUA treatment plan and shall be responsible for performing the chiropractic manipulation for that procedure. The “second chiropractor” shall insure that all movements are accomplished with patient care and safety as his or her primary focus and shall assist the “primary chiropractor” when necessary. The chiropractic portion of MUA is limited to techniques within the scope of practice of a chiropractor. (g) For the purpose of this section, the primary chiropractor and the second chiropractor may not be involved in nor interfere with the physician and surgeon or other health care provider in the discharge of the patient following the MUA procedure. 22 (h) Failure by a chiropractor to follow the standard of care contained in this section when performing MUA shall constitute unprofessional conduct. (i) “Manipulation Under Anesthesia” or “MUA” means the manipulation by a licensed chiropractor of a patient who is sedated by the administration of anesthesia by a physician and surgeon or other health care provider who is legally authorized to administer anesthesia. §319. Free or Discount Services. Licensees may advertise that they will perform certain designated routine professional services free or at a discount if such advertising claims are truthful. However, no charge shall be made for any other professional services rendered or commodities provided to a patient during any office visit in which free or discounted services are offered or provided unless, prior to the accrual of any charges, the patient shall have been informed of the cost of such additional services and/or commodities and shall have agreed to pay for them. For the purposes of this section, no separate charge shall be made for the professional evaluation of diagnostic tests or procedures which are provided free or without cost, or at a discount, whether such professional evaluation is made at the time of the initial office visit or at any later time. §319.1. Informed Consent. (a) A licensed doctor of chiropractic shall verbally and in writing inform each patient of the material risks of proposed care. “Material” shall be defined as a procedure inherently involving known risk of serious bodily harm. The chiropractor shall obtain the patient's written informed consent prior to initiating clinical care. The signed written consent shall become part of the patient's record. (b) A violation of this section constitutes unprofessional conduct and may subject the licensee to disciplinary action. Article 3. Application for License to Practice Chiropractic §320. Temporary Permits or Licenses. The California law does not provide for the granting of temporary permits or licenses. §321. Application for License. An Application for a License to Practice Chiropractic shall be submitted on an application form entitled “Application for License to Practice Chiropractic” (No. 09A-1 (Rev. 11/20)), which is hereby incorporated by reference, accompanied by such evidence, statements, or documents as are therein required, and filed with the board at its office in Sacramento, with the required nonrefundable application fee of three hundred seventy-one dollars ($371.00). The application shall also include verifications showing satisfactory completion of 60 prechiropractic college credits and the minimum educational requirements for licensure from the chiropractic college attended by the applicant on forms entitled “Verification of Prechiropractic Hours” (No. 09B-3 (New 07/14)) and “Chiropractic College Certificate” (No. 09B-2 (New 07/14)), which are hereby incorporated by reference. 23 § 321.1. Fingerprint Submission. (a) Applicants for licensure and petitioners for reinstatement of a revoked or cancelled license shall successfully complete a state and federal level criminal offender record information search conducted through the Department of Justice as provided in subdivision (b). (b) Applicants and petitioners shall submit to the Department of Justice electronic fingerprint images and related information required by the Department of Justice for the purpose of obtaining information as to the existence and content of a state or federal criminal record. The Department of Justice shall forward the fingerprint images and related information received to the Federal Bureau of Investigation and request federal criminal history information. The Department of Justice shall compile and disseminate state and federal responses to the board pursuant to subdivision (p) of Section 11105 of the Penal Code. The board shall request from the Department of Justice subsequent arrest notification service, pursuant to Section 11105.2 of the Penal Code, for each person who submitted information pursuant to this subdivision. The applicant or petitioner shall bear the cost of the fingerprinting. (c) Licensees who have either not previously submitted fingerprints to the board, or who were initially licensed prior to January 1, 1997, or for whom a record of an electronic submission of fingerprints no longer exists, or who are directed by the board shall successfully complete a state and federal level criminal offender record information search conducted through the Department of Justice as provided in subdivision (b) by the licensee's renewal date that occurs on or after June 1, 2011. A licensee's failure to comply with this requirement by the date designated by the board is unprofessional conduct and may result in the board taking disciplinary action against his or her license. (d)(1) In order to renew a license, licensees subject to subdivision (c) shall, in addition to meeting any other requirements for renewal of a license, certify on the renewal application that the licensee has successfully completed a state and federal level criminal offender record information search pursuant to subdivision (c). (2) Licensees shall retain, for at least three years, either a receipt showing that he or she has electronically transmitted his or her fingerprint images to the Department of Justice or, for those licensees who did not use an electronic fingerprinting system, a receipt evidencing that the licensee's fingerprints were taken. (e) The board may waive the requirements of subdivision (c) and (d) for licensees who are actively serving in the United States Military. §322. Age of Applicant. No applicant under the age of twenty-one (21) years of age shall be admitted to examination before the board for licensure to practice chiropractic in California. §323. Reciprocity. Interpretation of Section 9 of the Act. The board makes the following interpretation of Section 9 of the Act which states candidates for licensure are considered to have fulfilled the requirement of reciprocity if they provide the documentation required by the board showing the following: 24  (a) Graduation from a board approved chiropractic college, and completion of the minimum number of hours and subjects as were required by California law at the time the applicant's license was issued. (b) Equivalent successful examination in each of the subjects examined in California in the same year as the applicant was issued a license in the state from which he is applying. (c) They must hold a valid and up-to-date license from the state from which they are reciprocating. (d) The state from which they are licensed will reciprocate with California. (e) The board reserves the right to require any additional education or examination for reciprocity. (f) A nonrefundable application fee of $25.00. (g) A fee, as set forth in Section 5 of the Act, if licensure is granted. (h) Five (5) years of chiropractic practice. §325. Denial of License Application; Issuance of Probationary License. The board may refuse a license to any applicant for any of the grounds enumerated in Business and Professions Code Section 480. The board may, in its sole discretion, issue a probationary license to any such applicant who has met all other requirements for licensure. The board may issue the license subject to any terms or conditions not contrary to public policy, including, but not limited to, the following: (a) Medical, psychiatric, or psychological evaluation. (b) Continuing medical, psychiatric, or psychological treatment. (c) Restriction of practice. (d) Continuing participation in a board-approved rehabilitation program. (e) Abstention from the use of alcohol or drugs. (f) Random blood and or urine testing for alcohol or drugs. (g) Compliance with all laws and regulations. §325.1. License Reapplication. A person whose application for licensure was denied upon any of the grounds specified in Section 10(b) of the Act or Business and Professions Code section 480 may reapply after a period of not less than two years has elapsed from the date of the denial letter. A person whose application for licensure was denied and proceeded in accordance with the provisions of Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of 25 the Government Code may reapply for licensure two years form the effective date of the decision. §326. Rehabilitation Criteria for Denials, Reinstatements, and Reissuance of a License. (a) When considering the denial of a license under Section 480 of the Business and Professions Code or granting a petition for reinstatement under Section 1003 of the Business and Professions Code or restoration of a license pursuant to subdivision (c) of Section 10 of the Chiropractic Initiative Act of California, on the ground that the applicant or petitioner has been convicted of a crime, the Board shall consider whether the applicant or petitioner made a showing of rehabilitation if the applicant or petitioner completed the criminal sentence at issue without a violation of parole or probation. In making this determination, the Board shall consider the following criteria: (1) The nature and gravity of the crime(s). (2) The length(s) of the applicable parole or probation period(s). (3) The extent to which the applicable parole or probation period was shortened or lengthened, and the reason(s) the period was modified. (4) The terms or conditions of parole or probation and the extent to which they bear on the applicant’s or petitioner’s rehabilitation. (5) The extent to which the terms or conditions of parole or probation were modified, and the reason(s) for modification. (b) If the applicant or petitioner has not completed the criminal sentence at issue without a violation of parole or probation, or the Board determines that the applicant or petitioner did not make the showing of rehabilitation based on the criteria in subdivision (a), or the denial is based on professional misconduct, or the denial is based on one or more of the grounds specified in Section 10(b) of the Chiropractic Initiative Act of California, the Board shall apply the following criteria in evaluating an applicant’s or petitioner’s rehabilitation: (1) The nature and gravity of the act(s), professional misconduct, or crime(s) under consideration as grounds for denial. (2) Evidence of any act(s), professional misconduct, or crime(s) committed subsequent to the act(s), professional misconduct, or crime(s) under consideration as grounds for denial. (3) The time that has elapsed since commission of the act(s), professional misconduct, or crime(s) referred to in subparagraphs (1) or (2). (4) Whether the applicant or petitioner has complied with any terms of parole, probation, restitution, or any other sanctions lawfully imposed against the applicant. (5) The criteria in subdivision (a)(1) through (5), as applicable. (6) Evidence, if any, of rehabilitation submitted by the applicant or petitioner. 26 § 327 Rehabilitation Criteria for Suspensions or Revocations. (a) When considering the suspension or revocation of a license under Section 490 of the Business and Professions Code on the ground that the person holding the license has been convicted of a crime, the Board shall consider whether the licensee has made a showing of rehabilitation if the licensee completed the criminal sentence at issue without a violation of parole or probation. In making this determination, the Board shall consider the following criteria: (1) Nature and gravity of the crime(s). (2) The length(s) of the applicable parole or probation period(s). (3) The extent to which the applicable parole or probation period was shortened or lengthened, and the reason(s) the period was modified. (4) The terms or conditions of parole or probation and the extent to which they bear on the licensee’s rehabilitation. (5) The extent to which the terms or conditions of parole or probation were modified, and the reason(s) for modification. (b) If the licensee has not completed the criminal sentence without a violation of parole or probation, or the Board determines that the licensee did not make a showing of rehabilitation based on the criteria in subdivision (a), or the suspension or revocation is based upon a disciplinary action as described in Section 141 of the Business and Professions Code, or the suspension or revocation is based upon one or more of the grounds specified in Section 10(b) of the Chiropractic Initiative Act of California, the Board shall apply the following criteria in evaluating the licensee’s rehabilitation: (1) Nature and gravity of the act(s), disciplinary action(s), or crime(s). (2) Total criminal record. (3) The time that has elapsed since commission of the act(s), disciplinary action(s), or crime(s). (4) Whether the licensee has complied with any terms of parole, probation, restitution or any other sanctions lawfully imposed against the licensee. (5) If applicable, evidence of dismissal proceedings pursuant to Section 1203.4 of the Penal Code. (6) The criteria in subdivision (a)(1) through (5), as applicable. (7) Evidence, if any, of rehabilitation submitted by the licensee. 27  Article 4. Approved Schools and Qualifications of Applicants §330. Application for Approval. An application for approval on a form provided by the Board, shall be filed with the Board at its principal office in Sacramento and addressed to the Secretary of the State Board of Chiropractic Examiners. Such application shall be on file at least six months prior to any inspection. §331.1. Approval and Eligibility. (a) A school which initially meets the requirements of these rules shall be first provisionally approved. No school will be finally approved until a provisional program has been in operation for at least two years. (b) No school shall be provisionally approved until it shall present competent evidence of its organizational and financial ability to attain the minimum educational requirements set forth by these rules and institutional goals set forth in its application. (c) No school shall be provisionally approved unless there is a reasonable need for such school in the geographical area in which it is proposed to locate. (d) No school shall be provisionally approved until competent evidence of compliance with the requirements of Section 29023(a)(2) of the Education Code is filed with the Board. §331.2. Inspection and Survey. (a) No school shall be approved, provisionally or finally, until it has been inspected by the Board or its duly authorized representative, including but not limited to the Council on Chiropractic Education, and is found to be in compliance with the rules herein set forth. (b) Each school shall permit to the Board or its authorized representatives unhampered opportunity to inspect the school's facilities, interview its entire faculty and management, examine student, teaching, grading, performance and graduation records, and inspect and audit, for cause, at the school's expense, the financial and corporate records. §331.3. Supervision. (a) Every approved school shall be under the supervision of a full-time president, dean, or other executive officer who shall carry out the objective and program of the school. Said officer shall have a minimum of two years experience in school administration prior to his appointment, or its equivalent in training. (b) The president, dean, or other executive officer shall render a report annually, covering topics such as student enrollment, number and changes in faculty and administration, changes in the curriculum, courses given, and the projections for future policy. Said annual report shall be filed with the Board within one month following the end of the academic year. (c) It shall be the duty of the president, dean, or other executive officer to obtain from each faculty member, prior to the beginning of the semester or school year, an outline and time schedule for each subject of the course. He shall approve such outlines and determine from time 28 to time if they are being observed. A copy of this outline and a schedule of classes, showing the day and hour of presentation and the instructor shall be filed with the Board within three (3) weeks after the beginning of the term. (d) The dean shall maintain a record of the teaching load of each member of the staff in terms of classes taught, supervision, student counseling, committee work, and other assigned activities. (e) A permanent file of all class schedules, beginning with those as of the date of the school's approval shall be maintained by the dean. These shall be available for inspection and comparison with the courses described in the relative catalogs. (f) Schedules must be kept up to date and posted on a bulletin board available for student inspection. §331.4. Financial Management. The college shall keep accurate financial records and shall file an annual financial report including a profit and loss statement as well as an asset and liability statement prepared and signed by a qualified accountant. Said financial report shall be filed with the Board within three (3) months following the end of the school's fiscal year. §331.5. Records. There shall be maintained a good system of records, showing conveniently and in detail, the attendance, discipline, grades and accounts of the students, by means of which an exact knowledge can be obtained regarding each students work. A personal file must be maintained for each student containing his admission credentials, photographs and other identifying personal items. Fireproof storage must be provided for the safekeeping of records. §331.6. Catalog. The school shall issue, at least biennially, a catalog setting forth the character of the work which it offers, and said catalog shall be filed with the Board. The content and format shall follow the usual pattern of professional school catalogs, and shall contain the following information: (a) A list of its trustees, president, dean and other administrative officers and members of the faculty with their respective qualifications; (b) Courses set forth by department, showing for each subject its content, value in term, semester hours, or credit hours; (c) Entrance requirements, conditions for academic standing and discipline, such as attendance, examinations, grades, promotion and graduation; (d) Matriculation, tuition, laboratory, graduation and special fees, and estimated costs of books, instruments, dormitory and board; and (e) Descriptions of the library, audio-visual facilities, laboratories and clinic facilities setting forth at least the minimum requirement hereinafter set forth in rules. 29  (f) No school will be accepted or retained in good standing which publishes in its catalog or otherwise, any misrepresentation regarding its curriculum, faculty or facilities for instruction. §331.7. Calendar. Each school may elect to use the semester, trimester or four-quarter term system. A school calendar shall designate the beginning and ending dates of terms or semesters, the vacation periods and legal holidays observed, and the dates for semester and final examinations. The recitation or lecture period shall be not less than 50 minutes in length. The school may operate on a five or six-day week or any combination thereof, but the total number of hours of instruction shall be not less than 30 hours nor more than 35 hours per week. The total number of hours provided for each complete student's course, leading to the degree of Doctor of Chiropractic, shall be not less than 4,400 hours distributed over four academic years of nine months each. §331.8. Faculty. All faculty members shall meet the standards of the Council on Chiropractic Education. §331.9. Student Faculty Ratio. (a) The full-time equivalent student-faculty ratio shall be at least one full-time professor to every fifteen (15) students enrolled in the school. (b) A full-time professor is one who devotes a minimum of 38 hours per week to his academic duties. (c) The maximum enrollment for any class in laboratory or clinical work shall be limited to the number which may, by Board standards, sufficiently be trained with the equipment and facilities available in such laboratory clinic. (d) All classes and laboratory sessions, including clinics, shall be conducted under the presence and supervision of a full-time professor. (e) There shall be one instructor for each twenty-five (25) students in the laboratory and/or clinic courses. §331.10. Faculty Organization. (a) A faculty shall be organized by departments. Regularly scheduled meetings of the full faculty shall be had to provide a free exchange of ideas concerning: (1) The content and scope of the curriculum; (2) The teaching methods and facilities; (3) Student discipline, welfare and awards; (4) Faculty discipline and welfare; 30  (5) Committee reports and recommendations; (6) Recommendations for the promotion and graduation of students; (7) Administration and educational policies; and (8) Recommendations to the administrative officers and to the trustees. (b) The dean shall appoint the following standing committees of which he shall be a member ex officio: admissions and credentials, curriculum, clinic, laboratories, library and examinations, grades and records. §331.11. Scholastic Regulations. (a) Admission. (1) Each school shall have a committee on admissions and credentials. The admission of students shall be in the hands of a responsible officer who is a member of the committee and his decision shall be subject to the approval of the committee. (2) No applicant shall be admitted to any school until he has been personally interviewed for the purpose of determining his character, scholastic aptitude, mental and physical fitness to study and practice. When a great geographic distance precludes personal interview, the same information, supported by affidavits and photographs, may be substituted for the personal interview. (3) Documentary evidence of preliminary education must be obtained and kept on file. All transcripts of other schools must be obtained directly from such schools. (4) It is strongly recommended by the Board that an entrance examination compiled and administered by recognized testing agencies (e.g., A.C.T., S.A.T.) be required of all students prior to matriculation in order to prove their ability to do college level work. (b) Date of Matriculation. No student shall be matriculated at a later date than one week immediately following the advertised date of the commencement of the school term. (c) Qualifications of Students. No student shall be matriculated in an approved school unless he is of good moral character and is without major physical deficiencies, except as provided in Section 8.1 of the Act. (d) Professional Education. Students shall not be matriculated in any school approved by the board unless they possess, and submit to the school upon their application for matriculation, either: (1) A diploma from a standard high school or other institution of standard secondary school grade evidencing completion by the student of a four (4) year course, or (2) A certificate from the board stating that the student has submitted proof, satisfactory to the board, of education equivalent in training power to a high school course. The certificate shall bear a date prior to the applicant's matriculation date in any school approved by the board. 31  (3) A student who seeks admission in any school approved by the Board after November 3, 1976, shall be subject to the following: The candidate must have completed, with a satisfactory scholastic record, at least 60 semester hours or an equivalent number of quarter hours in prechiropractic subjects at a college listed in the U.S. Office of Education “Education Directory-- Higher Education.” The specific prechiropractic subjects and hour requirements shall be in accordance with the standards adopted by the Council on Chiropractic Education. (e) Advanced Standing. (1) Applicants for admission to advanced standing shall be required to furnish evidence to the school: (A) That they can meet the same entrance requirements as candidates for the first year class; (B) That courses equivalent in content and quality to those given in the admitting school in the year or years preceding that to which admission is desired have been satisfactorily completed; (C) That the work was done in a chiropractic college acceptable to the committee on admissions of the college; and (D) That the candidate has a letter of recommendation from the dean of the school from which transfer is made. (2) Credits for work done in colleges of liberal arts and sciences will be allowed based on the regulations of the Council on Chiropractic Education. (3) Credits for basic science subjects on the professional level shall be in accordance with the provisions of the regulations of the Council on Chiropractic Education. (4) A student desiring to re-enter the college after a lapse in attendance of one or more years shall fulfill the entrance requirements applying to the class which he seeks to enter. Students whose education was interrupted by service in the armed forces are exempt from this requirement. (5) For all such students admitted to advance standing there will be, therefore, on file with the registrar the same documents as required for admission to the first-year class and in addition a certified transcript of work completed, together with a letter of honorary dismissal from the college from which transfer was made. (6) No candidate for a degree shall be accepted for less than one full academic year of resident study. (f) Attendance. In order to obtain credit for a course, a student shall have been present in class at least 90 percent of the time and shall have received a passing letter grade. When the absence exceeds 10 percent, the student shall be automatically dropped from the class. If the absences have been due to illness or other excusable reasons and if evidence of these reasons can be submitted, the student may apply for readmission through the dean's office and may be given credit for attendance upon the recommendation of his instructor and completion of course requirements. 32  Students shall be required to spend the last academic year of the course in residence in the college which confers the degree. (g) Promotion. (1) Promotion from one school term to another should be by recommendation of the instructors and consent of the committee on credentials or other similar committee. The decision should be based upon careful evaluation of the student's attendance, application, conduct and grades in quizzes and examinations. In other words, the final standing of the student in each subject shall be based upon the composite judgment of the responsible instructors in that department, and not solely upon the result of written examinations. (2) A student failing in any subject in a school term should be required to repeat the subject. (h) Requirements for Graduation. The requirements for admission to the school shall have been fulfilled and the candidate, in addition to scholastic qualitative requirements, shall have completed a minimum quantitative requirement of 4,400 hours of instruction in four academic years of nine months each. The last year shall have been spent in the school granting the degree. The candidate shall have complied with all the regulations of the school and be recommended for the degree by the faculty. (i) Special (Graduate of An Approved Chiropractic School) or Unclassified Subject. Persons so registered may not be a candidate for a degree. If they desire to become candidates, they shall satisfy the usual requirements for admission as well as the degree requirement. No work done under this classification will be accepted for credit beyond 90 days from the date of matriculation. Holders of a valid chiropractic degree are exempt from this requirement. (j) Degree. The degree conferred for completion of professional undergraduate work shall be Doctor of Chiropractic (D.C.). §331.12.1. Curriculum. All applicants for the Board Examination who matriculated into a chiropractic college prior to the passage of Proposition 15 (November 3, 1976) shall fulfill the requirements of this section. (a) Course of Study. The school shall have established curriculum which indicates objectives, content and methods of instruction for each subject offered. (b) Required Hours and Subjects. The school shall offer, and shall require for graduation, a course of not less than 4,000 academic hours extended over a period of four school terms of not less than nine months each. Such course shall include the minimum educational requirements set forth in Section 5 of the Act. The minimum number of hours required in the basic subjects shall be as follows: Anatomy including embryology (minimum of 480 hours), histology (minimum of 160 hours), and dissection (minimum of 160 hours) 800 hours Physiology 320 hours Biochemistry, inorganic and organic chemistry 320 hours 33 Pathology (minimum of 280 hours), bacteriology (minimum of 160 hours), and toxicology (minimum of 40 hours) 480 hours Public health, hygiene and sanitation, and first aid 120 hours Diagnosis (minimum of 480 hours), pediatrics (minimum of 40 hours), psychiatry (minimum of 40 hours), dermatology, syphilology and serology (minimum of 40 hours), and X-ray (minimum of 120 hours) 720 hours Obstetrics and gynecology 120 hours Principles and practice of chiropractic (minimum of 960 hours), physiotherapy (minimum of 120 hours), and dietetics (minimum of 40 hours) 1,120 hours (c) Subject Presentation. Laboratory teaching with actual student participation must be included in anatomy, dissection, histology, chemistry, physiology, bacteriology, pathology. The classes shall be presented in a proper sequence so that the normal shall be presented first before the abnormal is to be considered (i.e., the student must learn anatomy, chemistry and physiology before he is taught pathology and diagnosis). The subject presentation should be of a nature and depth comparable to that found at State colleges in equivalent courses. ANATOMY: Includes gross anatomy, dissection, embryology, and histology with particular emphasis on neurology. PHYSIOLOGY: To include the physiology of blood and lymph, circulation, respiration, excretion, digestion, metabolism, endocrines, special senses and nervous system. CHEMISTRY: To include inorganic and organic chemistry, physical chemistry, the chemistry of foods, digestion and metabolism. PATHOLOGY AND BACTERIOLOGY: Pathology to include general and special pathology. Bacteriology to include parasitology and serology. PUBLIC HEALTH AND HYGIENE AND SANITATION: To include sanitary and hygienic procedures, First Aid, prevention of disease and Public Health Department regulations. DIAGNOSIS: To include physical, clinical, laboratory and differential diagnosis; pediatrics, geriatrics, dermatology, syphilology, psychology, psychiatry and roentgenology (technique and interpretation). OBSTETRICS AND GYNECOLOGY: To include the standard routine diagnostic procedures, and clinical and laboratory examinations. PRINCIPLES AND PRACTICE OF CHIROPRACTIC, DIETETICS, PHYSIOTHERAPY, AND OFFICE PROCEDURE: To include history and principles of chiropractic, spinal analysis, adjustive techniques and orthopedics. NUTRITION: To include dietetics and clinical nutrition, including primary and secondary nutritional deficiencies. 34  PHYSIOTHERAPY: To include the theory, principles and use of the standard recognized physiotherapy equipment and procedures. OFFICE PROCEDURE: To include private office and case management, the writing and completion of reports and forms for insurance claims, and the provisions, rules and regulations of the Chiropractic Act. (d) Additional Hours and Subjects. The school, if it desires, may offer and may require for graduation, course of more than 4,000 hours. Such additional hours may be in elective subjects. (e) Clinics. Each student shall be provided with actual clinical experience in the examining, diagnosing, and treatment of patients. Said clinical experience shall include spinal analysis, palpation, chiropractic philosophy, symptomatology, laboratory diagnosis, physical diagnosis, X- ray interpretation, postural analysis, diagnostic impressions, and adjusting of various articulations of the body, psychological counseling, dietetics and physical therapy. Individual case files on each patient together with a record of dates and treatments given and student treating shall be kept and available to the board for inspection. §331.12.2. Curriculum. All applicants for licensure shall be required to comply with this section in order to qualify for a California chiropractic license. (a) Course of Study: Every school shall have a curriculum which indicates objectives, content and methods of instruction for each subject offered. (b) Required Hours and Subjects: Each applicant shall offer proof of completion of a course of instruction in a Board-approved chiropractic college of not less than 4,400 hours which includes minimum educational requirements set forth in Section 5 of the Act. The course of instruction completed by the applicant shall consist of no less than the following minimum hours, except as otherwise provided: Group I Anatomy, including embryology, histology and human dissection 616 hours Group II Physiology (must include laboratory work) 264 hours Group III Biochemistry, clinical nutrition, and dietetics 264 hours Group IV Pathology, bacteriology, and toxicology 440 hours Group V Public health, hygiene and sanitation, and emergency care 132 hours Group VI Diagnosis, including E.E.N.T. and serology, dermatology and sexually transmitted diseases, geriatrics, X-ray interpretation, and neurology 792 hours Group VII Obstetrics, gynecology, and pediatrics 132 hours Group VIII Principles and practice of chiropractic to include chiropractic technique, chiropractic philosophy, orthopedics, X-ray technique, and radiation protection 430 hours Clinic, including office procedure 518 hours