Nature & Scope of Physiotherapy

The nature of physiotherapy
Physiotherapy is an autonomous health care profession which provides services to people and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan
Physiotherapists may work as:
• Clinicians providing direct intervention to patients/clients
• Educators of patients/clients, families, caregivers, students, other physiotherapists and the public at-large.
• Administrators
• Researchers

Physiotherapy is concerned with identifying and maximising movement potential within the spheres of promotion, prevention, treatment and rehabilitation. Physiotherapy involves the interaction between physiotherapist, patients/clients, families and caregivers, in a process of assessing movement potential and in establishing agreed upon goals and objectives, using knowledge and skills unique to physiotherapists.

The nature of the physiotherapy process
Physiotherapy is the service only provided by, or under the direction and supervision of a physiotherapist and includes assessment, diagnosis, planning, intervention and evaluation. Physiotherapy includes the provision of services in circumstances where movement and function are threatened by the process of injury, disease or that of aging

Assessment consists of both the examination of individuals or groups with actual or potential impairments or other conditions of health by: a) history taking b) screening c) the use of specific tests and measures and, d) evaluation of the results of the examination through analysis and synthesis within a process of clinical reasoning.

Diagnosis arises from the examination and evaluation and represents the outcome of the process of clinical reasoning. This may be expressed in terms of movement dysfunction or may encompass categories of impairments, abilities/ disabilities or syndromes.

Planning begins with determination of the need for intervention and normally leads to the development of a plan of intervention, including measurable outcome goals negotiated in collaboration with the patient/ client, family or caregiver. Alternatively it may lead to referral to another agency in cases which are inappropriate for physiotherapy.

Intervention is implemented and modified in order to reach agreed goals and may include:
* Manual handling
* Movement enhancement
* Physical, electro-therapeutic and mechanical agents
* Functional training
* Provision of aids and appliances
* Patient-related instruction/education and counseling
Evaluation necessitates re-examination for the purpose of evaluating outcomes.

The scope of physiotherapy services
Physiotherapy is an essential part of the health services delivery system. Physiotherapists practise independently of other health care providers and also within the interdisciplinary health care team for the restoration of optimal function and quality of life in individuals with loss and disorders of movement. Physiotherapists are guided by their own code of ethical principles. Thus, they may be concerned with one of the following purposes:

* Promoting the health and well being of the individual and the general public/society.
* Preventing impairments, functional limitations, and disabilities in individuals at risk of altered movement behaviours due to health or medically-related factors, socio- economic stresses and lifestyle factors.
* Providing interventions to restore integrity of body systems essential to movement, maximise function and recuperation, minimise incapacity, and enhance the quality of life in individuals and groups of individuals with altered movement behaviours resulting from impairments, functional limitations, and/or disabilities

Physiotherapists with relevant continuing education may provide:
• Orthopaedic manipulative therapy
• Acupuncture/meridian therapy
• Intervention for people with high risk and infectious diseases
• Physiotherapy in women’s health
• Sports physiotherapy
• Physiotherapy for older people
• Electromyography/electro diagnosis
• Cardiopulmonary rehabilitation
• Intervention complimentary to physiotherapy

Settings in which physiotherapy is practised
Physiotherapy is delivered in a variety of settings including but not confined to:
* Hospitals
* Out-patient clinics
* Rehabilitation centres
* Child development centres
* Sports clubs
* Fitness centres
* Schools/universities
* Senior citizen centres
*Community settings: Primary health and individual homes

Prevention and Health Promotion is more likely to occur in the following settings although they often form an integral part of treatment and rehabilitation offered within other care settings.
* Occupational Health Centres
* Workplace/Companies
* Public settings (e.g. shopping malls) for health promotion

STANDARDS OF PRACTICE
The Rationale for Standards
The Standards of Practice are designed primarily for physiotherapists in the UAE to:
(i) set professional development priorities that lead to improved client outcomes;
(ii) determine whether one is performing at an acceptable level for the specific type of practice;
(iii) promote the role and accountability of physiotherapists to other professionals and the public.

The standards can also be used as a tool by:
• Members of the public, to assess the quality of physiotherapy services they receive;
• Physiotherapy educators, to design entry-to-practice education and continuing education programmes; and,
• The Emirates Physiotherapy Society, to guide practice review and quality assurance.

Every physiotherapist has to comply with the Standards
As a member of a self-regulated health profession, the UAE physiotherapists are required to perform within the scope of practice and according to the guidelines and standards set by the Emirates Physiotherapy Society. Physiotherapists must be able to demonstrate the competencies described in this working document, and maintain the standards for both (a) the services delivered, either alone or in collaboration with a multidisciplinary team and, (b) any services rendered under one’s direction and supervision.

How the Standards were developed.
The Standards of Practice were developed following a survey of a variety of regional and international associations of Physiotherapy and the World Confederation of Physical Therapy (WCPT) documentation.

Criteria Guiding the Development of Standards
Development of the Standards of Practice was guided by principles that reflect beliefs and values intrinsic to the practice of physiotherapy.
1. Physiotherapists are bound by a code of ethics.
Physiotherapists are expected to abide by the profession's code of ethics. Physiotherapists are required to:
• practise with integrity and in accordance with the law;
• respect client values, dignity and well-being;
• promote the active involvement of clients in the decision-making process: and,
• demonstrate concern for improving community health and access to physiotherapy services, and for ensuring adequate physiotherapy education, research and administration.

2. Physiotherapists are committed to providing client-centred services.
Physiotherapists must ensure:
• the services they provide are responsive to, and respectful of, the needs, rights and sensitivities of diverse client groups; and,
• clients are given meaningful information, both to facilitate informed decision making and to foster their active involvement in the management strategy.

3. Physiotherapists are self-regulating.
Each physiotherapist is:
• accountable to both the public and the profession for the quality of service he or she provides;
• responsible for ensuring that his or her clinical and business practices are conducted in accordance with available evidence, and with the legal and ethical requirements of the profession and the community at large; and committed to providing needs-based, efficient and cost-effective services, and to building interdisciplinary linkages to promote continuity in the delivery of rehabilitative services.

4. Physiotherapists maintain competencies by building on their specialised body of knowledge.
Physiotherapists, as self-directed learners, are required to:
• critically appraise new health information and technology to enhance their knowledge and skill base; and,
• develop basic and advanced skills in assessment, clinical analysis and intervention through formal education, clinical experience and continuous quality improvement initiatives.

5. Physiotherapists exercise specialised problem-solving skills.
Physiotherapists are required to:
• integrate knowledge, skills and judgment to analyse problems and provide necessary and reasonable service, or refer clients to appropriate alternative care; and,
• make decisions in light of a client's need(s), the profession's Code of Ethics, the evidence of a particular area of practice and resource constraints.

6. Physiotherapists act as public advocates in identifying and addressing issues related to the delivery of rehabilitative services.
Physiotherapists are responsible for:
• understanding relevant practice-related legislation; and,
• representing, within the constraints of their practice environments, the broader needs of the client populations they serve.

How the Standards are Presented
The Standards of Practice are presented in four sections representing the main professional activities of physiotherapists:
I. Standards of Organisation / Administration
II. Standards of Quality Care
III. Standards of Legal Affairs & Ethics
IV. Standards of other professional activities: Education, Research and Community Services.

I. STANDARDS OF ORGANISATION/ ADMINISTRATION
A. Statement of Mission, Purposes, and Goalsِ
The physiotherapy service has a statement of mission, purposes, and goals that reflects the needs and interests of the patients and clients served, the physiotherapy personnel affiliated with the service, and the community.

The statement of mission, purposes, and goals:
 Defines the scope and limitations of the physiotherapy service.
 Identifies the goals and objectives of the service.
 Is reviewed annually¬.

B` Organizational Plan
The physiotherapy service has a written organisational plan.

The organisational plan:
• Describes relationships among components within the physiotherapy service and, where the service is part of a larger organi¬sation, between the service and the other components of that organisation.
• Ensures that the service is directed by a physiotherapist.
• Defines supervisory structures within the service.
• Reflects current personnel functions.

C. Policies and Procedures
The physiotherapy service has written policies and procedures that reflect the operation of the service and that are consistent with the mission, purposes, and goals of the service.

The written policies and procedures:
• Are reviewed regularly and revised as necessary.
• Meet the requirements of state law and external agencies.
• Apply to, but are not limited to:
• Clinical education
• Clinical research
• Interdisciplinary collaboration
• Criteria for access to care
• Criteria for initiation and continuation of care
• Criteria for referral to other appropriate health care providers
• Criteria for termination. of care
• Equipment maintenance
• Environmental safety
• Fiscal management
• Infection control
• Job/position descriptions
• Competency assessment
• Medical emergencies
• Care of patients and clients, including guidelines
• Rights of patients and clients
• Personnel-related policies improvement of quality of care and performance of services
• Documentation
• Staff orientation

D. Administration
A physiotherapist is responsible for the direction of the physiotherapy service.
The director of the physiotherapy service:
• Ensures compliance with local, state, and federal requirements.
• Ensures compliance with current Emirates Physiotherapy Society documents, including Standards of Practice and the Code of Ethics.
• Ensures that services are consistent with the mission, pur¬poses, and goals of the physiotherapy service.
• Ensures that services are provided in accordance with established policies and procedures.
• Reviews and updates policies and procedures.
• Provides for training that ensures continued competence of physiotherapy support per¬sonnel.
• Provides for continuous in-service training on safety issues and for periodic safety inspection of equipment by qualified individuals.

E. Fiscal Management
The director of the physiotherapy service, in consultation with physiotherapy staff and appro-priate administrative personnel, participates in planning for, and allocation of, resources. Fiscal planning and management of the service is based on sound accounting principles.

The fiscal management plan:
• Includes a budget that provides for optimal use of resources.
• Ensures accurate recording and reporting of financial information.
• Ensures compliance with legal requirements.
• Allows for cost-effective utilisation of resources.
• Uses a fee schedule that is con¬sistent with the cost of physiotherapy services and that is within customary norms of fairness and reasonableness.

F. Improvement of Quality of Care and Performance
The physiotherapy service has a written plan for continuous improvement of quality of care and performance of services.

The improvement plan:
• Provides evidence of ongoing review and evaluation of the physiotherapy service.
• Provides a mechanism for docu¬menting improvement in quality of care and performance.
• Is consistent with requirements of external agencies, as applicable.

G. Staffing
The physiotherapy personnel affiliated with the physiotherapy service demonstrate com-petence and are sufficient to achieve the mission, purposes, and goals of the service.

The physiotherapy service:
• Meets all legal requirements regarding licensure and certification of appropriate personnel.
• Ensures that the level of expertise within the service is appropriate to the needs of the patients and clients served.
• Provides for appropriate ratios of personnel to patients.
• Provides for appropriate ratios of support personnel to professional personnel.

H. Staff Development
The physiotherapy service has a written plan that provides for appropriate and on-going staff development.
The staff development plan:
• Includes self-assessment, individual goal setting, and orga¬nisational needs in directing continuing education and learning activities.
• Includes strategies for lifelong learning and professional and career development.

I. Physical Setting
The physical setting is designed to provide a safe and accessible environment that facilitates fulfill¬ment of the mission, purposes, and goals of the physiotherapy service. The equipment is safe and sufficient to achieve the purposes and goals of the service.
The physical setting:
• Meets all applicable legal requirements for health and safety.
• Meets space needs appropriate for the number and type of patients and clients served.

The equipment:
• Meets all applicable legal requirements for health and safety.
• Is inspected routinely.

J. Interdisciplinary Collaboration
The physiotherapy service collaborates with all appropriate disciplines.

The collaboration:
• Uses interdisciplinary/ multidisciplinary team approach to the care of patients and clients.
• Provides interdisciplinary/ multidisciplinary instruction of patients, clients, and families/ caregivers.
• Ensures interdisciplinary/multidisciplinary professional development and continuing education.

II. STANDARDS OF QUALITY CARE
A. Informed Consent
The physiotherapist has sole responsibility for providing infor¬mation to the patient and for obtaining informed consent in accordance with jurisdictional law before initiating intervention.

The information provided to patients:
• Clearly describes the proposed intervention.
• Delineates material (decisional) risks associated with the proposed intervention.
• Identifies expected benefits of the proposed intervention.
• Compares the benefits and risks that are possible both with and without the proposed intervention.
• Explains reasonable alternatives to the proposed intervention.

Informed consent:
• Requires consent of a competent adult.
• Requires consent of a parent/ legal guardian as the surrogate decision maker when the adult patient is not competent or when the patient is a minor.
• Requires the patient, client, or legal guardian to acknowledge understanding of the interven-tion and to give consent before intervention is initiated.

B. Assessment and Analysis
Condition:
• given a client who requests, or is referred for, a physiotherapy consultation and/or service
• as an independent process or as part of a multidisciplinary assessment

Objective:
• determine the diagnosis, i.e., the nature and extent of the client's dysfunction, as well as the need for physiotherapy service, and/or referral to another health professional

Timing:
• prior to planning and delivering a physiotherapy intervention or, in the case of a consultation, prior to reporting

Clinical Requirements
The physiotherapist:
1.1 Documents a relevant health history, or, in the case of a multidisciplinary assessment, reviews, and updates as necessary, the health history recorded by another team member.
1.2 Incorporates into the client's record supplementary information relating to the client's health status, health history and previous health management.
1.3 Collects relevant data by interviewing the client and performing a clinical examination as determined by the nature of the presenting impairment, disability and/or handicap.
1.4 Identifies the client's and/or family's goals for service and expected outcomes.
1.5 Where available and appropriate, uses standardised outcome measures to:
(i) assess the impact of the impairment, disability and/or handicap on the client's function;
(ii) establish baseline outcome measures; and,
(iii) assess the client's perceptions of his or her functional status and quality of life.

1.6 Analyses assessment findings and determines client abilities, functional problems and potential for change.
1.7 Records key observations, measurements and analyses in the client's chart.

Safety Requirements
1.8 Within the constraints of the practice setting, ensures services are provided in a clean, safe and accessible area.
1.9 Follows appropriate infection control procedures.
1.10 Exercises due precaution near hazards in the physical environment.
1.11 Refers clients to:
(i) another physiotherapist for consultation when the assessment is beyond his or her level of competence: or
(ii) another health professional. when additional investigations are beyond a physiotherapist's scope of practice.
1.12 Ensures that tasks assigned to auxiliary staff, students and volunteer personnel are appropriate and supervised in accordance with regulations and guidelines.

Interpersonal Requirements
1.13 Prior to commencing the assessment:
(i) informs the client and/or family about the nature and purpose of the assessment, as well as any personal financial costs associated with the assessment: and
(ii) asks the client to report any significant changes in his or her presenting problem (s) during the course of the assessment.

1.14 After the assessment:
(i) informs the client and/or family about the results of the assessment;
(ii) explains the nature of the problem and functional prognosis; and
(iii) provides rationale for consultation with another health professional, where necessary.

C. Planning
Condition:
• given a client for whom physiotherapy is indicated

Objective:
• develop, and reach agreement with the client on, an individualised, outcome-oriented intervention strategy

Timing:
• after initial assessment and following scheduled reassessment(s)

Clinical Requirements
The physiotherapist:
2.1 Promotes the active involvement of the client and/or family/caregivers in establishing goals with respect to client function and improvement in health-related quality of life.
2.2 Defines in the written plan, where appropriate, client-centred goals, the type and focus of intervention(s), the anticipated frequency and duration of service, relevant precautions and expected outcomes.
2.3 Uses, where available, evidence-based practice information to guide the development of the plan, taking into consideration client preferences, resource constraints and individual client factors (e.g., age, previous health history) that may alter expected outcomes.
2.4 Provides prompt written plans to third-party insurers upon request, and obtains necessary approval(s) prior to implementing service.
2.5 Collaborates with other members of the client's health care team to coordinate plans, support comprehensive service delivery and avoid service duplication.

Interpersonal Requirements
2.6 Prior to implementing the plan, promotes informed decision making by helping the client and/or family understand relevant information, including:
(i) client and/or family responsibilities relative to the plan;
(ii) the purpose and effect of specific interventions,
(iii) potential risks associated with the proposed plan;
(iv) the anticipated frequency and duration of service; and
(v) any personal financial costs associated with the plan.

2.7 Obtains consent to treatment in accordance with legislation.

D. Implementation
Condition:
• after the client has consented to a physiotherapy plan

Objective:
• deliver planned intervention(s) in accordance with current evidence/levels of competence
• provide instruction in self-¬management, health promotion and disease prevention

Timing:
• determined by the clinical response until significant functional benefit has been achieved

Clinical Requirements
The physiotherapist:
3.1 Performs physiotherapy interventions as determined by the presenting impairment, disability and/or handicap, and consistent with evidence-based practice information.
3.2 Ensures the extent, intensity and duration of the intervention is compatible with the client's general health status, functional needs and assessment findings.
3.3 Documents information about, and the client's response to, the interventions used.
3.4 Provides the client and/or family with relevant information about self-management, health promotion and disease prevention.
3.5 Maintains continuity in service delivery by:
(i) communicating effectively with physiotherapists and other health professionals who share responsibility for service delivery; and,
(ii) arranging for substitute care prior to vacations and/or extended absences from practice.

Safety Requirements
3.6 Within the constraints of the practice setting, ensures services are provided in a clean, safe and accessible area.
3.7 Refers the client to another physiotherapist when a specific intervention is beyond his or her scope of expertise and poses risk to the client.
3.8 Minimises the risk of an adverse reaction to an intervention by:
(i) performing appropriate testing before an intervention;
(ii) recognizing and documenting an adverse reaction to an intervention every time it occurs, and adjusting the plan of care or discontinuing service

3.9 Refrains from delegating the controlled acts of tracheal suctioning and spinal manipulation.
3.10 Ensures tasks assigned to auxiliary staff, students and volunteer personnel are appropriate, and supervised in accordance with regulations and guidelines.
3.11 Where possible, takes steps to verify that therapeutic equipment is maintained in safe working order, and equipment records comply with record-keeping regulations.
3.12 Follows appropriate infection control procedures.
3.13 Exercises due precaution near hazards in the physical environment.
3.14 Assesses the need for supervision and monitoring during an intervention, and refrains from leaving clients alone, unless they:
(i) are told how to contact the treating physiotherapist or auxiliary staff member: and
(ii) understand when, why and how to alert the treating physiotherapist or auxiliary staff member.

Interpersonal Requirements
3.15 Ensures clients are:
(i) oriented to the practice setting and provided with information about relevant policies (e.g., cancellation, absenteeism);
(ii) monitored and asked about changes in status during the intervention(s); and treated within an agreed-upon range of physical tolerance.

Exceptions include delegation to (a) physiotherapy students working under the supervision or direction of a physiotherapists; (b) a family member of the client who is part of the client's household and is responsible for the client's care; or, (c) a person who assists a client with his or her routine activities of living.

E. Ongoing Evaluation
Condition:
• given a client who has been receiving physiotherapy services
• in accordance with a specific management strategy
• as an independent process or as part of a multidisciplinary evaluation

Objective:
• evaluate client outcomes relative to the effectiveness of specific interventions and overall service

Timing:
• in accordance with significant changes in the client's functional status

Clinical Requirements
The physiotherapist who implements or supervises the physiotherapy plan:
4.1 Schedules reassessments.
4.2 Evaluates and updates intervention plans at a frequency congruent with the client's clinical profile, or after a reasonable length of time:
(i) with no clinical improvement; and/or
(ii) with a deterioration in functional status; and/or
(iii) with the onset of new symptoms.

4.3 Refrains from modifying intervention plans without a reassessment.
4.4 Reviews and adjusts the goals of clients in accordance with the needs and expected outcomes of the client and/or family, the significance of the clinical benefit(s) achieved and resource constraints.
4.5 Discusses with the client and/or family significant changes to the intervention strategy and reaches agreement on a revised plan.
4.6 Communicates the results of on-going evaluation with other members of the client's health care team to ensure comprehensive service delivery and avoid service duplication.

Interpersonal Requirements
4.7 Informs the client and/or family about the:
(i) nature and purpose of on-going and outcome evaluations;
(ii) results of on-going assessments.

F. Discharge
Condition:
• given a client who has been receiving physiotherapy services
• in accordance with a specific management strategy
• as an independent process or as part of a multidisciplinary evaluation

Objective:
• assist in planning for discharge as early as is feasible

Timing:
• in accordance with significant changes in the client's functional status when client is discharged

Clinical Requirements
The physiotherapist who implements or supervises the physiotherapy plan:
5.1 Discontinues interventions that are no longer necessary or effective.
5.2 Discontinues specific interventions when requested to do so by the client.
5.3 Plans discharge with the client by:
(i) determining the client's and/or family's level of knowledge about future service requirements,
(ii) recommending options for on-going service;
(iii) involving health professionals providing continuing care to the client,
(iv) determining the expectations of third-party insurers; and
(v) identifying resource constraints that may influence planning for discharge.

5.4 Recommends discharge of the client once significant clinical benefit has been achieved, or when the treating practitioner or referral source requests the discharge.
5.5 Discharges the client in accordance with Emirates Physiotherapy Society guidelines when:
(i) physiotherapy services are no longer indicated; or,
(ii) the client has requested that a specific intervention be discontinued, and is unable to reach agreement with the physiotherapist on an alternative management strategy.

5.6 Uses standardised measures, where available and appropriate, to compare impairment, disability and/or handicap on discharge with the baseline values recorded during the initial assessment.
5.7 Uses client satisfaction tools, where available and appropriate, to:
(i) determine how well services delivered and outcomes achieved met client expectations; and
(ii) identify opportunities to improve overall service delivery.

5.8 Where possible, obtains follow-up information from the client and/or family to evaluate the long-term effectiveness of specific interventions, as well as the adequacy of his or her overall service.
5.9 Participates in available programme evaluation and clinical effectiveness studies to support the development of outcomes research.

Interpersonal Requirements
5.10 Informs the client and/or family about the reasons why service is being discontinued.

G. Reporting
Condition:
• any written or verbal exchange - either formal or informal - about a client receiving physiotherapy services

Objective:
• provide timely, accurate and objective information about a client's assessment, treatment plan, intervention strategy and discharge

Timing:
• ongoing
• in accordance with client needs and response to treatment
• as required by the referral source or third-party payer

Clinical Requirements
The physiotherapist:
6.1 Ensures written and verbal reports are clear and unambiguous and explain physiotherapy terms when necessary.
6.2 Ensures written and verbal reports respect the autonomy, individuality and dignity of each client.
6.3 Bases recommendations and conclusions on an objective analysis of client response.
6.4 Protects confidentiality of client information in all personal communication and/or physiotherapy reports.
6.5 Ensures final discharge recommendations and conclusions respond to original referral questions and issues.

Interpersonal Requirements
6.6 Ensures the client and/or family is:
(i) informed about all personal financial costs associated with the report;
(ii) informed about the purpose and content of interim and final reports; and
(iii) given the opportunity to ask questions.

H. Record Keeping
Condition:
• given a client who is receiving or has received physiotherapy services within the last ten (10) years as an independent process or as part of a multidisciplinary team

Objective:
• ensure systemic recording of, and ready access to, accurate, objective and relevant information about a client

Timing:
• once a client is referred or makes a first appointment for an initial assessment
• at each repeat visit, until discharge and retention

Clinical Requirements
The physiotherapist:
7.1 Creates a clinical record for each client containing:
(i) the client's name, address and date of birth, the date of each professional visit, and the name and address of any referral source:
(ii) information regarding the client assessment, including the health history obtained or updated, an indication of the body part or system examined and significant findings, and his or her conclusion, problem formulation or other professional opinion of the client's condition;
(iii) the treatment plan for the client, including the specific treatment protocol, an indication of whether, and to whom, treatments might he delegated, a record of any home treatments, and the particulars of any referral;
(iv) every written report sent or received respecting the client;
(v) progress notes indicating both subjective and objective measures of the client's response to treatment;
(vi) a copy of each written consent.

7.2 Ensures every part of the clinical record has a reference identifying the client or the client health record.
7.3 Documents in every entry, in the clinical record, the date, the person who rendered the service, and the person who made the entry.
7.4 Keeps a daily record of appointments or workload, or both, containing the name of each client and the date of the client's visit.

Retention Requirements
7.5 Retains client records in the practice or institution for at least ten (10) years after the date of the last entry in the record.
7.6 Where applicable, retains records of the inspection, maintenance and repair of all equipment used to render physiotherapy services for at least five (5) years after the date of the last entry in the record.
7.7 Ensures all records are legibly written, typewritten, or stored in a computer system, provided the system can:
(i) display the recorded information visually;
(ii) enter each client record via the client's name and date of birth;
(iii) print a separate record for each client;
(iv) visually display and print the recorded information for each client in chronological order;
(v) provide reasonable protection against unauthorized access;
(vi) provide automatic back-up and recovery of files, or otherwise protect against loss of, damage to, and inaccessibility of information; and,
(vii) maintain an audit trail, which records the date and time of each entry and subsequent change, preserves the original content when changes are made, and identifies the person making the entry and rendering the service.

7.8 Where applicable, keeps a financial record for each client containing:
(i) the service and product provided;
(ii) the cost of each service and product;
(iii) the date each service and product is provided;
(iv) the date of receipt of payment;
(v) any outstanding balance.

Interpersonal Requirements
7.9 Informs the client of any fee associated with the release of the record or report at the time the request is made.

Release Requirements
7.10 Provides a copy of the record to the client or his or her authorised representative upon request.
7.11 Refrains from releasing information from a client's clinical record without the client's permission, unless:
(i) the informational copies are to be used for health administration or planning or health research or epidemiological studies;
(ii) the use of the information or copies is in the public interest; and
(iii) anything that could identify the client is removed from the information or copies.

III. STANDARDS OF LEGAL AFFAIRS & ETHICS
Legal Considerations
The physiotherapist complies with all the legal requirements of jurisdictions regulating the practice of physiotherapy.

Ethical Considerations
The physiotherapist practises according to the Code of Ethics of the Emirates Physiotherapy Society.

IV. STANDARDS OF OTHER PROFESSIONAL ACTIVITIES

Education
1. The physiotherapist is responsible for individual professional development.
2. The physiotherapist partici¬pates in the education of physiotherapy students and students in other health professions.
3. The physiotherapist educates and provides consultation to con¬sumers and the general public regarding the purposes and benefits of physiotherapy.
4. The physiotherapist educates and provides consultation to other health care providers regarding the purposes and benefits of physiotherapy.

Research
1. The physiotherapist applies research findings to practice.
2. The physiotherapist encourages, participates in, and promotes activities that establish the outcomes of patient/client management provided by the physiotherapist.
3. The physiotherapist supports collaborative and interdisciplinary research.

Community Responsibility
The physiotherapist participates in community and community agency activities, educates the public, including prevention education and health promotion, helps formulate public policy, and provides physiotherapy services.