Chapter 446

CHAPTER 446

CHIROPRACTIC EXAMINING BOARD

446.01   Definitions.

446.02   Chiropractic regulated.

446.025   Regulation of chiropractic radiological technicians.

446.026   Regulation of chiropractic technicians.

446.028   Continuing education approval; program sponsors.

446.03   Reprimand; revocation, limitation, or suspension of a license or certificate.

446.04   Unprofessional conduct.

446.05   Procedure for hearings.

446.06   Injunction to enforce this chapter.

446.07   Penalty.

446.08   Informed consent.

Ch. 446 Cross-reference Cross-reference: See definitions in s. 440.01.

446.01 446.01 Definitions. In this chapter:

446.01(1d) (1d) “Adjunctive services” means services that are preparatory or complementary to the practice of chiropractic. “Adjunctive services” includes all of the following:

446.01(1d)(a) (a) The taking and preparation of preliminary patient histories, as defined by the examining board by rule.

446.01(1d)(b) (b) Providing physiotherapy treatment, as defined by the examining board by rule.

446.01(1h) (1h) “Chiropractic radiological technician” means an individual who holds a certificate as a chiropractic radiological technician granted by the examining board.

446.01(1p) (1p) “Chiropractic technician” means an individual who holds a certificate as a chiropractic technician granted by the examining board.

446.01(1t) (1t) “Examining board” means chiropractic examining board.

446.01(1v) (1v) “Health care professional” means an individual who is licensed, registered, or certified by any of the following:

446.01(1v)(a) (a) Board of nursing under ch. 441.

446.01(1v)(b) (b) Dentistry examining board under subch. I of ch. 447. “Health care professional” also includes an individual who holds a compact privilege under subch. II of ch. 447.

446.01(1v)(c) (c) Medical examining board under subch. II of ch. 448.

446.01(1v)(d) (d) Physical therapy examining board under subch. III of ch. 448. “Health care professional” also includes an individual who holds a compact privilege under subch. XI of ch. 448.

446.01 Note NOTE: Par. (d) is shown as affected by 2021 Wis. Acts 23 and 251 and as merged by the legislative reference bureau under s. 13.92 (2) (i). The cross-reference to subch. XI of ch. 448 was changed from subch. X of ch. 448 by the legislative reference bureau under s. 13.92 (1) (bm) 2. to reflect the renumbering under s. 13.92 (1) (bm) 2. of subch. X of ch. 448.

446.01(1v)(e) (e) Podiatry affiliated credentialing board under subch. IV of ch. 448.

446.01(1v)(f) (f) Dietitians affiliated credentialing board under subch. V of ch. 448.

446.01(1v)(g) (g) Athletic trainers affiliated credentialing board under subch. VI of ch. 448.

446.01(1v)(h) (h) Occupational therapists affiliated credentialing board under subch. VII of ch. 448. “Health care professional” also includes an individual who holds a compact privilege under subch. XII of ch. 448.

446.01 Note NOTE: The cross-reference to subch. XII of ch. 448 was changed from subch. XI of ch. 448 by the legislative reference bureau under s. 13.92 (1) (bm) 2. to reflect the renumbering under s. 13.92 (1) (bm) 2. of subch. XI of ch. 448.

446.01(1v)(i) (i) Optometry examining board under ch. 449.

446.01(1v)(j) (j) Pharmacy examining board under ch. 450.

446.01(1v)(k) (k) The department of safety and professional services under ch. 451.

446.01(1v)(L) (L) Psychology examining board under ch. 455. “Health care professional” also includes an individual who is exercising the temporary authorization to practice, as defined in s. 455.50 (2) (o), in this state or practicing under the authority to practice interjurisdictional telepsychology, as defined in s. 455.50 (2) (b).

446.01(1v)(m) (m) Marriage and family therapy, professional counseling, and social work examining board under subch. I of ch. 457. “Health care professional” also includes an individual who is exercising the professional counselor privilege to practice, as defined in s. 457.50 (2) (s), in this state.

446.01(1v)(n) (n) Hearing and speech examining board under subch. II of ch. 459.

446.01(1v)(o) (o) The massage therapy and bodywork therapy affiliated credentialing board under ch. 460.

446.01(2) (2) “Practice of chiropractic” means:

446.01(2)(a) (a) To examine into the fact, condition, or cause of departure from complete health and proper condition of the human; to treat without the use of drugs as defined in s. 450.01 (10), other than hemp, as defined under s. 94.55 (1), or surgery; to counsel; to advise for the same for the restoration and preservation of health or to undertake, offer, advertise, announce or hold out in any manner to do any of the aforementioned acts, for compensation, direct or indirect or in expectation thereof; and

446.01(2)(b) (b) To employ or apply chiropractic adjustments and the principles or techniques of chiropractic science in the diagnosis, treatment or prevention of any of the conditions described in s. 448.01 (10).

446.01 History History: 1975 c. 383; 1977 c. 418 s. 929 (41); 1985 a. 146 s. 8; 2009 a. 28; 2017 a. 180; 2019 a. 68, 100; 2021 a. 23 s. 71; 2021 a. 123, 131, 251; 2023 a. 55, 88; s. 13.92 (1) (bm) 2.; s. 13.92 (2) (i).

446.01 Cross-reference Cross-reference: See also s. Chir 4.01, Wis. adm. code.

446.01 Annotation A physician, subject to certain limitations, may advise a patient whether or not continued chiropractic care is necessary without engaging in the unauthorized practice of chiropractic. 68 Atty. Gen. 316.

446.01 Annotation Physical therapists and massage therapists are not prohibited from performing the activities that are within their respective scopes of practice, even if those activities extend in some degree into the field of chiropractic science. OAG 1-01.

446.02 446.02 Chiropractic regulated.

446.02(1) (1) Except as provided in sub. (9), no person may engage in the practice of chiropractic or attempt to do so or hold himself or herself out as authorized to do so, unless such person satisfies all of the following:

446.02(1)(a) (a) Is licensed by the examining board.

446.02(1)(b) (b) Submits evidence satisfactory to the examining board that the person meets the requirements of continuing education for license renewal as the examining board may require, which requirements shall include current proficiency in the use of an automated external defibrillator achieved through instruction provided by an individual, organization, or institution of higher education approved under s. 46.03 (38) to provide such instruction. The person shall include the approval number assigned under sub. (5) (b) to each educational program completed by the person to satisfy the requirements of this paragraph. During the time between initial licensure and commencement of a full 2-year licensure period new licensees shall not be required to meet continuing education requirements. Any person who has not engaged in the practice of chiropractic for 2 years or more, while holding a valid license under this chapter, and desiring to engage in such practice, shall be required by the examining board to complete a continuing education course at a school of chiropractic approved by the examining board or pass a practical examination administered by the examining board or both.

446.02(2) (2) 

446.02(2)(a) (a) The examining board shall grant a license to engage in the practice of chiropractic to a qualified person who submits an application for the license to the department on a form provided by the department, accompanied by satisfactory evidence of completion of the educational requirements established in the rules promulgated under par. (b), passes the examinations described under sub. (3) and pays the license fee specified in s. 440.05 (1).

446.02(2)(b) (b) The examining board shall promulgate rules establishing educational requirements for obtaining a license under par. (a). The rules shall require that an application for the license that is received by the department after June 30, 1998, be accompanied by satisfactory evidence that the applicant satisfies all of the following:

446.02(2)(b)1. 1. Has a bachelor’s degree from a college or university accredited by an accrediting body listed as nationally recognized by the secretary of the federal department of education.

446.02(2)(b)2. 2. Has graduated from a college of chiropractic approved by the examining board.

446.02(2)(b)3. 3. Has current proficiency in the use of an automated external defibrillator achieved through instruction provided by an individual, organization, or institution of higher education approved under s. 46.03 (38) to provide such instruction.

446.02(2)(b)4. 4. Has successfully completed the examinations required under sub. (3).

446.02(2)(c) (c)

446.02(2)(c)1. 1. The examining board shall issue a certificate to a chiropractor who is licensed under this chapter, who submits satisfactory evidence that the chiropractor has completed 48 hours of postgraduate study in nutrition that is approved by the examining board, and who pays a one-time certificate fee of $25, except that no certificate fee is required under this subdivision for an individual who is eligible for the veterans fee waiver program under s. 45.44.

446.02(2)(c)2. 2. The examining board shall approve under subd. 1. a program of postgraduate study in nutrition provided by a program sponsor, as defined in s. 446.028 (1), if the program of postgraduate study in nutrition satisfies all of the requirements established by the examining board by rule for such a program.

446.02(3) (3) The examining board shall require each applicant for licensure to successfully complete the following examinations:

446.02(3)(b) (b) Parts I, II, III, and IV of the examination administered by the National Board of Chiropractic Examiners. An applicant successfully completes Part III of that examination if the applicant scores at least 375 on that part. An applicant successfully completes Part IV of that examination if the applicant scores at least 375 on that part.

446.02(3)(c) (c) An examination approved by the examining board that tests the applicant’s knowledge of the laws of this state relating to the practice of chiropractic, including the provisions of this chapter and any rules promulgated by the examining board under this section.

446.02(3g) (3g) 

446.02(3g)(a) (a) The examining board may grant a license to practice chiropractic to an individual who is licensed in good standing to practice chiropractic in another state or territory of the United States or in another country if the applicant presents the license to the examining board, pays the fee specified in s. 440.05 (2) and meets the requirements established in rules promulgated under par. (b).

446.02(3g)(b) (b) The examining board shall promulgate rules establishing additional requirements for obtaining a license under par. (a), including a requirement that each person licensed under this subsection has current proficiency in the use of an automated external defibrillator achieved through instruction provided by an individual, organization, or institution of higher education approved under s. 46.03 (38) to provide such instruction.

446.02(3r) (3r) The examining board may promulgate rules providing for the granting of a temporary permit to practice chiropractic to an individual who is licensed to practice chiropractic in another state or territory of the United States or in another country, and establishing requirements for practicing chiropractic under a temporary permit. Any rules promulgated under this subsection shall require an individual seeking a temporary permit under this subsection to submit evidence satisfactory to the examining board that the individual has current proficiency in the use of an automated external defibrillator achieved through instruction provided by an individual, organization, or institution of higher education approved under s. 46.03 (38) to provide such instruction.

446.02(4) (4) The renewal date for all licenses granted by the examining board is specified under s. 440.08 (2) (a), and the renewal fee for such licenses is determined by the department under s. 440.03 (9) (a).

446.02(5) (5) 

446.02(5)(a) (a) The examining board shall keep a complete record of all applications, examinations, licenses, fees and proceedings.

446.02(5)(b) (b) The examining board shall assign a unique approval number to each continuing education program approved by the examining board under s. 446.028.

446.02(6) (6) No person may practice chiropractic in this state under any other given name or any other surname than that under which he or she was originally licensed or registered to practice chiropractic in this or any other state in any instance in which the examining board, after a hearing, finds that practicing under the changed name operates to unfairly compete with another practitioner or to mislead the public as to identity or to otherwise result in detriment to the profession or the public. This subsection does not apply to a change of name resulting from marriage or divorce.

446.02(6m) (6m) No chiropractor may provide counsel, direction, guidance, advice, or a recommendation to a patient regarding the health effects of vitamins, herbs, or nutritional supplements unless the chiropractor has been issued a certificate under sub. (2) (c) 1. This subsection does not apply to a chiropractor licensed under this chapter who is certified as a dietitian under subch. V of ch. 448.

446.02(7) (7) 

446.02(7)(a) (a) Except as provided in pars. (b) and (d), a chiropractor who is licensed under this chapter may delegate to a person who is not licensed under this chapter the performance of adjunctive services if the services are performed by any of the following under the direct, on-premises supervision of the chiropractor:

446.02(7)(a)1. 1. A chiropractic technician.

446.02(7)(a)2. 2. A health care professional.

446.02(7)(a)3. 3. An individual who has completed a training program for medical assistants accredited by the National Commission for Certifying Agencies, a national or state medical association, or another entity approved by the examining board.

446.02(7)(b) (b) A chiropractor may not delegate to a person who is not licensed under this chapter the making of a diagnosis, the performance of a chiropractic adjustment, the analysis of a diagnostic test or clinical information or any practice or service that the examining board, by rule, prohibits a chiropractor from delegating to a person who is not licensed under this chapter.

446.02(7)(c) (c) A chiropractor who delegates the performance of a service that is adjunctive to the practice of chiropractic to a person who is not licensed under this chapter shall verify, according to standards and procedures established by the examining board by rule, that the person has adequate education, training and experience to perform the delegated service safely, and is responsible for that person’s performance of the delegated service.

446.02(7)(d) (d) A chiropractor may delegate X-ray services only to a chiropractic radiological technician or a health care professional acting within the scope of his or her license, registration, or certification.

446.02(7d) (7d) 

446.02(7d)(a) (a) A chiropractor shall evaluate each patient before commencing treatment of the patient to determine whether the patient has a condition that is treatable by the practice of chiropractic. The evaluation shall be based upon an examination that is appropriate to the patient. To conduct the evaluation, the chiropractor shall utilize chiropractic science, as defined by the examining board by rule, and the principles of education and training of the chiropractic profession.

446.02(7d)(b) (b) A chiropractor shall discontinue the practice of chiropractic on a patient if, at any time after the evaluation under par. (a) or during or following treatment of the patient, the chiropractor determines or reasonably believes that the patient’s condition is not treatable by the practice of chiropractic, or will not respond to further practice of chiropractic by the chiropractor, except that a chiropractor may provide maintenance, supportive, and wellness care to the patient if the patient is being treated by another health care professional.

446.02(7d)(c) (c) A chiropractor who discontinues the practice of chiropractic as required in par. (b) shall inform the patient of the reason for discontinuing the practice of chiropractic and shall refer the patient to a physician licensed under subch. II of ch. 448. A chiropractor may continue to provide maintenance, supportive, and wellness care to a patient referred under this paragraph who requests these services from the chiropractor. A referral under this paragraph shall describe the chiropractor’s findings. If the referral is written, the chiropractor shall provide the patient with a copy and shall maintain a copy in the patient’s records. If the referral is oral, the chiropractor shall communicate the referral directly to the physician, shall notify the patient about the referral, and shall make a written record of the oral referral. The written record of the oral referral shall include the name of the physician to whom the patient was referred and the date of the referral. The chiropractor shall maintain a copy of the written record of the oral referral in the patient’s records.

446.02(7m) (7m) 

446.02(7m)(a) (a) A chiropractor shall create and maintain a patient record for every patient the chiropractor examines or treats. A patient record created and maintained under this paragraph shall contain complete and comprehensive health care information, as defined by the examining board by rule.

446.02(7m)(b) (b) A chiropractor shall preserve a patient record created and maintained under par. (a) for at least 3 years after the chiropractor makes his or her last entry or notation in the patient record or for any longer period that is otherwise required by law.