Laurie wrote:
> Other allied health care providers are physical therapists, occupational
> therapists, respiratory therapists, for example, and don't they work under
> a primary hcp and have "orders" to see the patient?

Lara wrote:
-They certainly don't work only under "orders" here (and what
-paternalistic and authoritarian overtones that term carries!).

In my part of the USA, almost all allied health care providers including OT’s, PT’s, SLT’s, Pharmacist’s must have physician (M.D.) orders. They are independent providers, however they must provide under the direction of a physician. Hence, they will evaluate a client then submit a report of findings and recommendations to the client’s primary physician, who will then sign the “orders” and “plan” saying they agree. Midwives can't order labs or sono's, so any expectant mother must also be under the care of an Obstetrition or Family physician to have any testing ordered. Pharmacists can not prescribe anything, however they can consult and make recommendations which may or may not be implemented by the primary physician. Massage therapists and Chiropractors are a bit different. They are independent, and do not require orders from anyone. But if they are credentialed with the insurance, they have to have a “referral” from the primary physician in most cases to get paid by the insurance.

The only exception to this is mental health care. Psychologists, psychiatrists, counselors, social workers, etc., do not require referral from primary care and they are not required to report anything to primary care. 

Now, having said all that, a client is free to seek second opinions, transfer care, and seek care where ever they choose. The caveat is if they want their insurance to pay for it or not. They may call a PT, OT, or SLT and request care, however they will be asked to provide a prescription for therapy from their physician prior to the evaluation.

Angela Hartfelder IBCLC, RLC

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