THE CROATIAN PARLIAMENT 3437 Pursuant to Article 88 of the Constitution of the Republic of Croatia, I hereby issue the DECISION PROMULGATING THE ACT ON PHYSIOTHERAPY PROFESSION I hereby promulgate the Act on Physiotherapy Profession, passed by the Croatian Parliament at its session on 3 October 2008. Class: 011-01/08-01/132 Reg. No: 71-05-03/1-08-2 Zagreb, 10 October 2008 The President of the Republic of Croatia Stjepan Mesić, m.p. ACT ON PHYSIOTHERAPY PROFESSION I GENERAL PROVISIONS Article 1 This Act regulates the contents and method of operation, educational standard, conditions for pursuing an activity, duties, quality control and professional supervision over the work of physiotherapists in the Republic of Croatia. The provisions of this Act relating to physiotherapists shall also adequately apply to physiotherapy technicians, occupational therapists and massage therapists-bath therapists engaged in the process of physiotherapy care of the patient, taking into consideration their scope of work. Article 2 Physiotherapists are health care workers, their activity is an integral part of health care activity of public interest for the Republic of Croatia, and shall be pursued under conditions and in a manner stipulated by this Act. A Bachelor Physiotherapist is a health care worker carrying out physiotherapy treatments and managing the process of physiotherapy. Physiotherapy technicians, occupational therapists and massage therapists-bath therapists who are registered with the Croatian Chamber of Physiotherapists may also take part in the physiotherapy care of the patients.
Physiotherapy technicians and massage therapists-bath therapists who are taking part in physiotherapy care within physiotherapy, shall carry out activities from their scope of work according to instructions and plan and programme prepared by a physiotherapist. II PHYSIOTHERAPISTS' ACTIVITY Article 3 Physiotherapists' activity shall include all procedures, knowledge and skills of physiotherapy. When pursuing its activity, a physiotherapist shall use its best technical knowledge, observing the principle of patients' rights, ethical and expert principles intended to protect the health of the population and of each patient on a personal level. A physiotherapist shall keep all information regarding patient's health condition as a professional secret. Article 4 Physiotherapists shall pursue their profession on all levels of health care, in accordance with standards to be laid down by the minister competent for health with an ordinance, following the proposal of the Croatian Chamber of Physiotherapists. Physiotherapists, physiotherapy technicians, occupational therapists and massage therapistsbath therapists may also pursue their profession outside the health care system within the framework of prevention and promotion of health, subject to conditions referred to in Article 15, paragraphs 1, 2 or 3 of this Act. Article 5 Physiotherapy is a public profession and shall be subject to control of compliance with the educational standards. Article 6 Pursuing physiotherapy must be based on the needs of the population, and in accordance with the plan and programme of health care measures. III EDUCATION EDUCATIONAL STANDARD FOR PHYSIOTHERAPISTS Article 7 Physiotherapists shall acquire basic education by completing a physiotherapy study at university level which provides high level of education in accordance with the regulations in the field of higher education. Article 8 By finishing the study referred to in Article 7 of this Act a right to the title Bachelor Physiotherapist shall be acquired.
Article 9 The supervision over the work of a physiotherapist - trainee may be performed only by a physiotherapist having an authorisation for independent work (a licence). ADDITIONAL TRAINING OF PHYSIOTHERAPISTS Article 10 Additional training of physiotherapists shall be carried out in case when the scope and complexity of activities and results anticipated require additional education from a certain field of health care. Additional training shall be carried out for the purpose of improving quality and efficiency of physiotherapists' work. Article 11 An increased or changed complexity of activities shall be determined on the basis of contents and type of procedures and skills expected from physiotherapists at particular levels of health care, and shall be related to changed needs of population and patients for physiotherapy care, new scientific findings and new diagnostic and therapeutic procedures. The need, contents and duration of additional training programme of physiotherapists shall be determined by a general legal act adopted by the Croatian Chamber of Physiotherapists. Article 12 Additional training of physiotherapists may be carried out in institutions of higher learning, health institutions and in other legal entities in accordance with the Statute of the Croatian Chamber of Physiotherapists. CONTINUOUS PROFESSIONAL TRAINING Article 13 Physiotherapists, physiotherapy technicians, occupational therapists and massage therapistsbath therapists in physiotherapy shall continuously update acquired knowledge and adopt new skills in accordance with the latest achievements and findings in the field of physiotherapy care. Continuous professional training shall be conducted by participating in professional seminars, courses and expert conferences. The contents, terms and procedure of continuous professional training and assessment of competence of physiotherapists, physiotherapy technicians, occupational therapists and massage therapists-bath therapists in physiotherapy shall be stipulated by a general legal act of the Croatian Chamber of Physiotherapists.
IV CONDITIONS FOR PURSUING THE PHYSIOTHERAPY PROFESSION Article 14 A physiotherapist who has been entered in the physiotherapists' register of the Croatian Chamber of Physiotherapists and who holds a licence shall have the right to pursue physiotherapy profession. A physiotherapist who has completed traineeship and passed a state exam shall have the right to be entered into a physiotherapists' register. The requirements of completed traineeship and passed state exam referred to in paragraph 2 of this Article shall not apply to citizens of EU Member States. The provisions of the Health Care Act and implementing regulations adopted pursuant to this Act shall apply to the contents, duration of traineeship and method of taking the state exam for physiotherapists. Article 15 A physiotherapist shall have the right to work independently, namely to pursue physiotherapy profession for which the licence was granted to him/her. An occupational therapist engaged in the physiotherapy care shall have the right to work independently, namely to pursue physiotherapy profession for which the licence was granted to him/her. A physiotherapy technician and a massage therapist-bath therapist shall have the right to work independently, namely to pursue physiotherapy profession for which the licence was granted to him/her. The licence referred to in paragraph 1, 2 and 3 of this Article shall be a public document granted, or denied by an administrative act adopted by the body determined by the Statute of the Croatian Chamber of Physiotherapists. An appeal shall not be admitted against the administrative act referred to in paragraph 4 of this Article, but an administrative dispute may be instituted. The licence of a physiotherapist, physiotherapy technician, occupational therapist and massage therapist-bath therapist in physiotherapy shall be renewed every six years. The conditions, method and procedure of granting, renewal and withdrawal of licence of a physiotherapist, physiotherapy technician, occupational therapist and massage therapist-bath therapist in physiotherapy shall be stipulated by a general legal act of the Croatian Chamber of Physiotherapists. V PHYSIOTHERAPISTS' DUTIES Article 16 A physiotherapist shall take a patient into a physiotherapy treatment according to indication for physiotherapy by a doctor and prepare a plan and programme of physiotherapy in accordance with the referred doctor's diagnosis. Physiotherapist's duties shall be the following: to implement physiotherapy treatments according to defined programmes, rules and protocols in team work, to apply scientifically valued methods and techniques regarding success, permanent and safe use based on evidence from the field of physiotherapy, to apply methods of problem-solving in implementing physiotherapy treatments requiring
the skill of analytically-critical approach, to co-operate with all team members and associates, to maintain correct, exhaustive and dated medical records in accordance with harmonised standards at the European level, which record all implemented procedures and which can at all times provide sufficient data concerning patient's condition in all stages of physiotherapy, to act conscientiously while working, to keep professional secret, to know and respect patients' rights, to respect the physiotherapy code of ethics and deontology, to respect patients' religious beliefs, to use the tools and instruments and equipment economically and efficiently, to act in the interest of the patient. Physiotherapists are responsible for: truthfulness of data entered, safety of patients during carrying out their duties, medicine and equipment taken in hand and used by them during the pursuing of profession. General duties and responsibilities for physiotherapy technicians, occupational therapists and massage therapists-bath therapists who provide services in physiotherapy shall be stipulated by a general legal act of the Croatian Chamber of Physiotherapists. Article 17 A physiotherapist shall record all administered procedures in the physiotherapy records for each individual patient at all levels of health care. Physiotherapy records shall contain the following: initial assessment and documentation for each patient, objective of the therapy, plan of therapy/treatment undertaken, periodic re-evaluation and its documenting for each patient, documented discharge of patients, including the response towards the physiotherapy treatment at the time of discharge, date and time of the service provided and physiotherapist's signature. Additional functional tests and measurements shall be attached to the physiotherapy records. A detailed contents of the physiotherapy records shall be determined by a general legal act of the Croatian Chamber of Physiotherapists. SERIOUS VIOLATION OF DUTY Article 18 A physiotherapist shall commit a serious violation of duty if he/she: refuses to provide physiotherapy care to the patient according to doctor's instruction for physiotherapy, incorrectly and irregularly applies physiotherapy treatments, fails to inform a doctor about patient's worsening condition during the physiotherapy treatment, fails to refer the patient to the doctor, when he/she establishes findings within the physiotherapy treatment which are not within the scope of physiotherapists' knowledge, inflicts damage to patient's health due to negligence or ignorance, applies methods and techniques which are not within the scope of description of his/her
work, violates the honour and reputation of his/her profession by his/her behaviour, violates the provisions of this Act, violates the physiotherapy code of ethics and deontology. The Croatian Chamber of Physiotherapists shall by a general legal act identify violations of duties and disciplinary responsibility of physiotherapy technicians, occupational therapists and massage therapists-bath therapists providing the services in physiotherapy. EXEMPTION FROM RESPONSIBILITY FOR PHYSIOTHERAPISTS Article 19 A physiotherapist shall not be responsible if a patient consciously refuses to engage in the physiotherapy treatment. A physiotherapist shall not be responsible for not-administered treatment in case when, despite the application of the best knowledge, the employer failed to provide technical equipment, administered medicine, tools and minimum instruments necessary. Article 20 Physiotherapists, physiotherapy technicians, occupational therapists and massage therapistsbath therapists shall be held responsible for minor and serious violations of duty before disciplinary bodies of the Croatian Chamber of Physiotherapists. Disciplinary measures for minor and serious violations of duty shall be determined by a general legal act of the Croatian Chamber of Physiotherapists. VI QUALITY CONTROL Article 21 Quality control of carrying out of physiotherapy profession shall be implemented by a specially trained physiotherapist appointed by the employer in co-operation with the ministry competent for health and the Croatian Chamber of Physiotherapists. Quality control of the physiotherapist's work shall particularly include: physiotherapy care plan, implementation of physiotherapy treatments, physiotherapy care results and its impact on patient's health status. VII PRIVATE PRACTICE Article 22 Private practice may be pursued only by a physiotherapist with completed physiotherapy study having a licence issued by the Croatian Chamber of Physiotherapists. The provisions of the Health Care Act shall apply to the procedure of establishment, temporary suspension and termination of physiotherapist's private practice.
VIII THE CROATIAN CHAMBER OF PHYSIOTHERAPISTS Article 23 The Croatian Chamber of Physiotherapists (hereinafter: the Chamber) shall be an autonomous and independent professional organisation with the capacity of legal person and public authorities. The Chamber shall represent interests of physiotherapists, physiotherapy technicians, occupational therapists and massage therapists-bath therapists pursuing activities in physiotherapy in the territory of the Republic of Croatia. The Chamber shall have its coat of arms, mark, sign and seals. The seat of the Chamber shall be in Zagreb. Article 24 Physiotherapists shall compulsorily become members of the Chamber. Physiotherapy technicians, occupational therapists and massage therapists-bath therapists engaged in the physiotherapy care shall compulsorily become members of the Chamber. Article 25 The Chamber shall perform the following public authorities: keep register of its members, issue, renew and withdraw licences, carry out professional supervision over the work of physiotherapists, physiotherapy technicians, occupational therapists and massage therapists-bath therapists pursuing activities in physiotherapy. The method and condition under which professional supervision referred to in paragraph 1, subparagraph 3 of this Article is carried out shall be stipulated by a general legal act of the Chamber subject to approval by the minister competent for health. Article 26 In addition to public authorities referred to in Article 25 of this Act, the Chamber shall also perform the following activities: 1. adopt the physiotherapy code of ethics and deontology, 2. co-operate with the ministry competent for health in all areas of interest for physiotherapists and provides expert opinions and participates in the preparation of regulations from the field of physiotherapy profession, 3. adopt the contents of physiotherapy guidelines for the plan and implementation of physiotherapy care, 4. propose the standards and norms for the physiotherapy profession to the minister competent for health, 5. identify the need, contents and duration of additional training programme for physiotherapists, 6. adopt general legal act defining the contents, terms and the procedure of continuous professional training and assessment of competence of physiotherapists, physiotherapy technicians, occupational therapists and massage therapists-bath therapists, 7. organise continuous professional training for physiotherapists, physiotherapy technicians, occupational therapists and massage therapists-bath therapists and implement assessment of
competence, 8. prescribe the method of advertising and method of accentuating the name of the private practice, 9. determine the lowest prices for particular physiotherapy activities which fall outside the basic network of health care, establish prices for particular physiotherapy activities from the scope of voluntary health insurance, 10. conduct professional supervision over the work of physiotherapists, physiotherapy technicians, occupational therapists and massage therapists-bath therapists who are engaged in provision of services in physiotherapy, 11. identify violation of duty of physiotherapists, physiotherapy technicians, occupational therapists and massage therapists-bath therapists, 12. lay down disciplinary measures for minor and serious violations of duty of physiotherapists, physiotherapy technicians, occupational therapists and massage therapistsbath therapists engaged in provision of services in physiotherapy care, 13. conduct disciplinary proceeding and pronounce disciplinary measures for violations of duty of physiotherapists, physiotherapy technicians, occupational therapists and massage therapists-bath therapists engaged in provision of services in physiotherapy care, 14. co-operate with health inspection of the ministry competent for health, 15. co-ordinate relations between the members and actively participate in resolving eventual disputes, 16. co-operate with the World Health Organisation, World Confederation for Physical Therapy and other international organisations of interest to physiotherapy, 17. perform other activities set out by this Act, the Statute and other regulations of the Chamber. Article 27 Chamber shall have a Statute. The Statute shall be the fundamental general legal act of the Chamber adopted by the Assembly of the Chamber. The Statute of the Chamber shall be approved by the minister competent for health. The Statute of the Chamber shall contain the following provisions concerning: the name and the seat, the field in which the Chamber operates, internal organisation, the bodies of the Chamber, their composition, authorities, method of decision-making, conditions and method of appointment and recall, duration of mandate and the responsibility of members, property and disposal of prospective profits, method of acquisition of property, attaining the public nature of the work of the Chamber, members and membership fees, the rights, obligations and disciplinary responsibility of the members, termination of the work of the Chamber and procedure with property in the event of termination of work of the Chamber. Article 28 The founder of the Chamber shall be the Ministry of Health and Social Welfare, the Croatian Association of Physiotherapists and the Croatian Society of Physiotherapists. Article 29 The supervision over the legality of work of the Chamber in performing its public authorities shall be performed by the ministry competent for health. In implementing the supervision referred to in paragraph 1 of this Article, the ministry
competent for health may request relevant reports and data from the Chamber. The Chamber shall submit the reports and data referred to in paragraph 2 of this Article to the minister competent for health within 30 days, or within the same period report about the reasons why it is not possible to submit them. The Chamber shall submit annual work report to the minister competent for health, by the 1st of March of the following year for the previous year. Article 30 The Chamber shall notify the ministry competent for health, other state administration bodies and competent bodies of local and regional self-government units, at its own initiative or at their request, about the status and problems in physiotherapy profession and the measures to be taken in order to advance the physiotherapy profession and in order to improve health care of citizens. The Chamber shall co-operate with state bodies and local and regional self-government bodies in resolving the problems in physiotherapy profession. The Chamber shall decide on co-operation with other chambers of health workers in the Republic of Croatia, as well as with chambers of physiotherapists of other countries. Article 31 To achieve its objectives and fulfil its tasks, the Chambers shall acquire the funds from: entry fee, membership fee, other revenues collected through the Chamber's activity. The State Budget of the Republic of Croatia shall provide for the funds for carrying out tasks referred to in Article 25, paragraph 1, subparagraph 3 of this Act which the Chamber performs pursuant to public authorities. IX CRIMINAL PROVISIONS Article 32 A fine in the amount of HRK 3 000.00 to 10 000.00 shall be imposed for an offence to a physiotherapist, physiotherapy technician, occupational therapist and massage therapist-bath therapist who: 1. fails to fulfil the obligation of keeping the professional secret (Article 3, paragraph 3), 2. carries out physiotherapy profession, without being registered (Article 2, paragraph 3 and Article 14, paragraph 1), 3. performs independent work without the licence (Article 15, paragraphs 1, 2 and 3), 4. makes professional supervision impossible or disrupts it (Article 25, paragraph 1, subparagraph 3), 5. fails to eliminate faults identified by professional supervision.
X TRANSITIONAL AND FINAL PROVISIONS Article 33 The Ministry of Health and Social Welfare, the Croatian Association of Physiotherapists and the Croatian Society of Physiotherapists shall establish the Chamber within six months after the date of entry of this Act into force. The minister competent for health shall, in co-operation with the Croatian Association of Physiotherapists, appoint a founding committee of the Croatian Chamber of Physiotherapists within three months after the date of entry of this Act into force. The Chamber shall adopt the general legal acts stipulated by this Act and the Statute of the Chamber within six months from the date of establishment. Article 34 The regulations for the adoption of which the minister competent for health is authorised by this Act, shall be adopted within six months from the date of entry of this Act into force. Article 35 Senior physiotherapists which on the date of entry of this Act into force pursue physiotherapy profession, and who carry out work according to up to now valid provisions, may continue to pursue this profession provided that they obtain the licence in accordance with this Act within two years. Physiotherapy technicians, occupational therapists and massage therapists-bath therapists which on the date of entry of this Act into force pursue physiotherapy profession, who carry out work according to up to now valid provisions, may continue to pursue this profession provided that they obtain the licence in accordance with this Act within two years. Article 36 This Act shall enter into force on the eighth day after the day of its publication in the Official Gazette, with the exception of Article 14, paragraph 3 thereof, which shall enter into force on the day of entry of the Republic of Croatia into the European Union. Class: 500-01/08-01/09 Zagreb, 3 October 2008 THE CROATIAN PARLIAMENT The President of the Croatian Parliament Luka Bebić, m.p.