By the Division of Professional Licensure

The Massachusetts Board of Registration of Chiropractors has voted to adopt the following policy guideline. This guideline is intended as a recommended protocol for the profession to follow. A policy guideline does not have the force or effect of law, as would a Massachusetts General Law or board rule or regulation. The Board utilizes this and other guidelines as an internal management tool in formulating decisions that relate to issues of chiropractic practice.

Date: April 2, 2009

Policy # 09-002


The Massachusetts Board of Registration of Chiropractors ("the Board") issues this policy to provide guidance to licensees regarding the delegation of supportive procedures to unlicensed assistants.

A licensed chiropractor may permit an unlicensed assistant to perform certain services which do not require licensure, registration or certification, including but not limited to supportive procedures, in a manner consistent with accepted chiropractic standards appropriate to the assistant's skill. In delegating procedures to staff, chiropractors must adhere to all applicable Board regulations, including but not limited to, 233 CMR 4.02 and 233 CMR 4.03. Those regulations prohibit chiropractors from delegating any clinical function for which licensure, registration or certification is required by state law or regulations to any person who does not possess the required license, registration or certification. When delegating permissible procedures, the Board recommends that chiropractors adhere to the following guidelines.

  1. The patient must be properly evaluated by the licensed chiropractor and a determination made that a supportive procedure or therapy is clinically indicated before any supportive procedure or therapy may be applied to the patient by an unlicensed assistant during the same patient visit.
  2. The licensed chiropractor must make all clinical decisions regarding the type of supportive procedure or therapy to be applied, the location to which such supportive procedure or therapy will be applied, and the duration and intensity of the supportive procedure or therapy where applicable.
  3. The licensed chiropractor must generally supervise the unlicensed assistant in the application of any supportive procedure or therapy by being present on the premises and readily available to provide direction and guidance to the unlicensed assistant throughout the performance of the supportive procedure or therapy.
  4. The licensed chiropractor must ensure that the assistant possesses a sufficient level of education and training in the application and use of the supportive procedure or therapy. The licensed chiropractor must maintain written documentation of the education and training possessed by each office assistant regarding the proper application and use of supportive procedures and therapies.
  5. The licensed chiropractor must properly report and code any supportive procedure or therapy in a manner consistent with appropriate reporting and coding requirements.