PITAHC Guidelines National Certification of Chiropractic

Purpose and declared policy

The guidelines prescribe the procedures and guidelines for implementing the PITAHC Implementing Rules and Regulation (IRR) on the National Certification of Chiropractic under Rule VI, Promotion, Advocacy and Training of IRR of R.A. 8423 (Rule I, Section 2).
The guidelines establish accreditation standards for chiropractic programs, training centers, and clinics to pursue continuous service improvement and strengthen accountability of stakeholders in traditional and alternative health care practices (Rule I, Section 2).
Republic Act No. 8423 policy is implemented by improving the quality and delivery of health care through the development of traditional and alternative health care and its integration into the national health care delivery system (Rule I, Section 3).
The guidelines aim to facilitate qualified and safe practice of chiropractic and protect the public and chiropractic health care consumers (Rule I, Section 4).

Definitions for chiropractic certification

“Chiropractic” is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuro-musculoskeletal system and their effects on general health, emphasizing manual techniques including joint adjustment and/or manipulation with a particular focus on subluxations (Rule I, Section 5(a)).
“Chiropractor” is a duly-registered and licensed health care professional engaged in chiropractic practice concerned with neuro-musculoskeletal issues and their effects on general health, emphasizing manual techniques with a particular focus on subluxations (Rule I, Section 5(b)).
“Adjustment” means a chiropractic therapeutic procedure using controlled force, leverage, direction, amplitude and velocity applied to specific joints and adjacent tissues to influence joint and neuro-physiological function (Rule I, Section 5(c)).
“Joint manipulation” is a manual procedure involving directed thrust to move a joint past the physiological range of motion without exceeding the anatomical limit (Rule I, Section 5(f)).
“Joint mobilization” is a manual procedure without thrust where the joint remains within its physiological range of motion (Rule I, Section 5(g)).
“Spinal manipulative procedures” include all procedures where hands or mechanical devices mobilize, adjust, manipulate, apply traction, massage, stimulate, or otherwise influence the spine and para-spinal tissues to influence chiropractic health care consumer health (Rule I, Section 5(j)).
“Subluxation” is a lesion or dysfunction in a joint or motion segment where alignment, movement, integrity and/or physiological function are altered while contact between joint surfaces remains intact (Rule I, Section 5(k)).
“National Certification” is the process of issuing certificates requiring education and training that assures practitioner and trainer competency, administered by PITAHC and other PITAHC accredited institutions (Rule I, Section 5(o)).
“National Accreditation” is the process of issuing certificates to training programs, centers and clinics (Rule I, Section 5(p)).
“Code of Ethics” is a summary of standards by which chiropractors agree to conduct practice and a declaration of general principles of acceptable, ethical, professional behavior (Rule I, Section 5(q)).

Who may practice chiropractic

No person may engage in the practice of chiropractic in the Philippines unless all national certification educational and technical qualifications are met (Rule III, Section 1(A)).
Eligibility requires that the person is a Filipino citizen, is at least twenty-one (21) years of age, has completed the prescribed chiropractic course in a learning institution accredited by PITAHC, has satisfactorily passed the chiropractic certification examination, and holds a valid Certificate of Registration duly issued by PITAHC in cooperation with the National Certification Committee for Chiropractic (Rule III, Section 1(A)).
The chiropractic course must fall into one of the defined course categories, including: a full-time bachelor’s degree in health sciences majoring in chiropractic; graduate school-level training for those with certain health-related backgrounds leading towards a Doctor in Chiropractic; or review of chiropractic degrees from other countries through an equivalency panel to align courses to the Philippine curriculum (Rule III, Section 1(B)).
Learning institutions may offer chiropractic courses only after securing necessary CHED accreditation/authorization and submitting specified accreditation requirements (Rule III, Section 1(C)).
Chiropractic, chiropractic learning institutions, and students must comply with the World Health Organization Guidelines on Basic Training and Safety in Chiropractic, appended and integrated as Annex “A” (Rule III, Section 1(E)).

National Certification Committee structure

PITAHC’s Director General invites active Filipino chiropractic practitioners to form the National Certification Committee for Chiropractic (Rule II, Section 1).
The invitation is valid for a period indicated and is renewable at the option of the PITAHC Director General (Rule II, Section 1).
The Committee is composed of five (5) sector representatives appointed by the PITAHC Director General, including: the PITAHC Director General as Ex-officio Chairman; three (3) duly-licensed practicing chiropractors; one (1) Medical Doctor preferably from the Philippine Medical Association (PMA); and one (1) educator preferably from the Commission on Higher Education (CHED) (Rule II, Section 1(a)).
The first three (3) appointed members have a term of three (3) years, while the remaining two (2) members have a term of two (2) years, renewable (Rule II, Section 1(a)).
Sectoral recommenders must be PITAHC duly-certified Filipino chiropractors, a medical doctor, and an educator practicing in the Philippines, of good moral character, who have not violated professional ethical standards (Rule II, Section 1(a)).
Committee actions require: a majority vote of the five (5) representatives in a duly called meeting attended by a majority (three (3) of 5), and are subject to PITAHC approval (Rule II, Section 1(b)).
The PITAHC Director General casts the vote in the event of a tie when quorum exists (Rule II, Section 1(b)).
The PITAHC Advocacy and Training Division Chief and Standard and Accreditation Division Chief serve as permanent representatives (Rule II, Section 1(c)).
The Standard and Accreditation Division serves as the Committee Secretariat (Rule II, Section 1(d)).

Committee powers and certification operations

The Committee develops and maintains chiropractic assessments based on competency standards and the Code of Ethics (Rule II, Section 2(a)).
The Committee formulates, reviews, and recommends policies to PITAHC relating to chiropractic education and practice (Rule II, Section 2(b)).
The Committee recommends and advises PITAHC on certification and related administration, including chiropractic certification issuance and the administration of chiropractic licensure (Rule II, Section 2(c)).
The Committee reviews and approves continuing education courses for chiropractors (Rule II, Section 2(d)).
The Committee accredits chiropractic training programs, centers, schools, and clinics (Rule II, Section 2(e)).
The Committee administers national certification assessments for chiropractic competency standards (Rule II, Section 2(f)).
The Committee certifies practitioners (Rule II, Section 2(g)).
The Committee revokes certification/accreditation of practitioners and of training centers, schools, and clinics for chiropractic (Rule II, Section 2(h)).
The Committee safeguards public trust by upholding the PITAHC Code of Ethics for Chiropractors (Rule II, Section 2(i)).
The Committee reviews and approves research proposals on chiropractic and recommends these to PITAHC for approval and/or funding (Rule II, Section 2(j)).
The Committee may organize sub-committees for accreditation, development of chiropractic education standards and guidelines, licensure certification, and other necessary functions (Rule II, Section 2).
A Technical Working Group (TWG) on Education is convened to develop the chiropractic curriculum (Rule II, Section 2).

Chiropractic education and standards

A chiropractic education program must include recognized program basic science components through chemistry, physics, and biology either as prerequisites or within the first-year curriculum (Rule III, Section 1(B), 1).
Preclinical science components generally include anatomy, physiology, biochemistry, pathology, microbiology, pharmacology and toxicology, psychology, dietetics and nutrition, and public health (Rule III, Section 1(B), 2).
Clinical science components generally include history-talking skills and physical examination (Rule III, Section 1(B), 3).
Chiropractic science and additional subjects generally include applied neurology and applied orthopedics; clinical biomechanics including specific chiropractic and biomechanics; chiropractic health care consumer assessment through methods such as gait and postural analysis, static and motion palpation, assessment of soft tissue tone and function; compliance with diagnostic imaging and analysis laws and regulations; history, principles and health care philosophy pertinent to chiropractic; ethics and jurisprudence on chiropractic practice; and background studies of traditional medicine and complementary/alternative health care (Rule III, Section 1(B), 4).
Chiropractic health care consumer management interventions include manual procedures (particularly spinal adjustment and spinal manipulation), other joint manipulation and joint mobilization, soft-tissue and reflex techniques; exercise and rehabilitative programs and active care; psychosocial aspects of chiropractic care; chiropractic education on spinal health, posture, nutrition, and lifestyle modifications; emergency treatment and acute pain management as indicated; supportive measures that may include back supports and orthotics; and recognition of contraindications, risk management, limitations of chiropractic care, and referral protocols (Rule III, Section 1(B), 5).
Documentation and clinical recordkeeping must cover recording of primary complaints, health history, physical examination, findings, assessment, diagnosis and treatment plan; accurate documentation of every chiropractic encounter; re-examination findings and documentation of modifications to care plans; confidentiality and privacy; consent obligations; and insurance and legal reporting (Rule III, Section 1(B), 6).
Research must include basic research methodology and biostatistics; interpretation of evidence-based procedures/protocols and best practice principles; epidemiological approach to clinical recordkeeping and encouragement to document case studies and participate in field research; and critical-thinking approaches in clinical decision-making using published papers and relevant clinical guidelines (Rule III, Section 1(B), 7).

Accreditation of chiropractic learning institutions

Learning institutions may offer chiropractic programs only after securing CHED authorization for operation of a baccalaureate program or Doctor on Chiropractic and establishing chiropractic education and programs (Rule III, Section 1(C), 1).
Learning institutions must provide certification of incorporation/registration with the Securities and Exchange Commission, including their latest Articles of Incorporation, By-Laws, General Information Sheet, and Financial Statements indicating incorporation as a non-profit, non-proprietary institution (Rule III, Section 1(C), 2).
Learning institutions must submit a proposed chiropractic curriculum that complies with the Rules’ requirements (Rule III, Section 1(C), 3).
Learning institutions must have a governing board including representation reflecting the public interest and a full time chief administrative officer qualified by education and/or experience (Rule III, Section 1(C), 4).
Learning institutions must present a legally constituted governing board resolution committing the institution to follow accreditation Standards, Policies and Procedures prescribed by the National Certification Committee for Chiropractic (Rule III, Section 1(C), 5).
Learning institutions must publish statements available to the public showing commitment to accepted professional ethical standards, especially for student recruitment and public information (Rule III, Section 1(C), 6).
Learning institutions must submit a written plan and a description of a functioning planning and evaluation process identifying and integrating future educational, physical and financial development and incorporating review and improvement procedures (Rule III, Section 1(C), 7).
Learning institutions may invite and hire services of foreign lecturers recognized internationally as experts in chiropractic to augment teaching personnel, subject to approval by the National Certification Committee for Chiropractic and the Department of Labor and Employment (Rule III, Section 1(D)).
Chiropractic safety components must follow the World Health Organization Guidelines on Basic Training and Safety in Chiropractic through Annex “A” (Rule III, Section 1(E)).

Fees, accreditation validity, and renewal

An application fee is collected from applicants who have complied with requirements for national certification assessments; the application fee may be changed anytime after committee review (Rule III, Section 2).
An accreditation fee and an additional accreditation certification fee are collected based on national accounting rules and regulations from applicants who have complied with accreditation requirements; the accreditation fee may be changed anytime after PITAHC review (Rule III, Section 3).
A Certificate of Accreditation granted under these guidelines is valid for three (3) years, subject to renewal, suspension, or cancellation for cause determined by the PITAHC Committee (Rule III, Section 4).
Accreditation renewal must be made on or before its expiration date (Rule III, Section 5).
A penalty is charged on a per-year basis for non-renewal by chiropractors according to national accounting rules and regulations; the penalty fee may be changed anytime after PITAHC review (Rule III, Section 5).

Transitory rules and foreign practitioners

Chiropractors already practicing in the Philippines at the effectivity of the Rules are exempted from taking national certification and may register as chiropractors with the National Certification Committee for Chiropractic if they are Filipino citizens, at least twenty-one (21) years of age, and certified by a learning institution recognized by PITAHC (Rule IV, Section A).
Chiropractors covered by the exemption must register within thirty (30) days from the date of effectivity of the Rules (Rule IV, Section A).
Foreign chiropractors seeking to practice in the Philippines must submit to the National Certification Committee for Chiropractic, within ninety (90) days from the date of effectivity of the Rules, proof that they met requirements for the three (3) categories through accredited learning institutions, and proof of equivalent licensure examination or proof of licensure credentials from at least one other country where chiropractic is developed and regulated (Rule IV, Section B, 1–2).
Both Filipino and foreign chiropractors who are already practicing and those who desire to practice must submit a certificate that their practice in the Philippines will be supervised by a duly licensed Filipino chiropractic for six (6) months (Rule IV, Section B).
The National Certification Committee for Chiropractic is authorized to review foreign chiropractors’ requirements to prove credentials and competence (Rule IV, Section B).
PITAHC appoints the National Certification Committee for Chiropractic members within fifteen (15) days from the date of effectivity (Rule IV, Section C).
Until members are appointed, the Ad Hoc Committee for Chiropractic (AHCC) performs the duties and functions of the National Certification Committee for Chiropractic, as provided in the guidelines (Rule IV, Section C).
The AHCC ceases exercising those duties and functions immediately after the Committee members are appointed by PITAHC (Rule IV, Section C).

Effectivity and suspension of inconsistent issuances

The guidelines take effect fifteen (15) days after publication in the Official Gazette or in at least two (2) newspapers of general circulation (Rule V, Section 1).
All issuances inconsistent with the provisions of PITAHC Circular No. 01, Series of 2010 are suspended or amended (Rule V, Section 1).