RULE I
  Policy and Application

Section 1. Title. These guidelines shall be known as the PITAHC Guidelines on the National Certification of Chiropractic.

Section 2. Purpose. These Guidelines are promulgated to prescribe the procedures and guidelines for the implementation of the PITAHC Implementing Rules and Regulation (IRR) on the National Certification of Chiropractic pursuant to Rule VI, Promotion, Advocacy and Training of IRR of RA 8423. These Rules also serve the accreditation of chiropractic programs, training centers and clinics to pursue continuous service improvement, and strengthen the accountability of all stakeholders in the traditional and alternative health care practices.

Section 3. Declaration of Policy. It is the policy of the State to improve the quality and delivery of health care services to the Filipino people through the development of traditional and alternative health care and its integration into the national health care delivery system.

Section 4. Objectives. The Philippine Institute of Traditional and Alternative Health Care (PITAHC), in accordance with its powers and functions under Section 6 of R.A. No. 8423, herein recognizes that Chiropractic under Section 5(a) of this Guidelines, is an accessible, beneficial and affordable alternative mode of health care that will contribute significantly to public health. In order to facilitate qualified and safe practice of chiropractic as well as to protect the public and chiropractic health care consumers, the objectives of these Guidelines are:

1. To develop standards and guidelines of the Chiropractic practice, which must be consistent with the existing laws on mainstream medical practice;
2. To guide PITAHC on the regulation of Chiropractic practice;
3. To certify and endorse chiropractors and accreditation of training programs and/learning institutions, clinics, and organizations;
4. To guide PITAHC in setting the minimum requirements for chiropractic education recommended by CHED;
5. To develop Chiropractic Code of Ethics

Section 5. Definition of Terms. For the purpose of these guidelines, the following terms and words and phrases shall mean or be understood as follows:

a) Chiropractic - It is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuro-musculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual techniques, including joint adjustment and/or manipulation, with a particular focus on subluxations. (WHO definition)

b) Chiropractor - A duly-registered and licensed health care professional engaged in the practice of chiropractic, concerned with health issues of the neuro- musculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual techniques, including joint adjustment and/or manipulation, with a particular focus on subluxations.

c) Adjustment - Any chiropractic therapeutic procedure that ultimately uses controlled force, leverage, direction, amplitude and velocity, which is applied to specific joints and adjacent tissues. Chiropractors commonly use such procedures to influence joint and neuro-physiological function.

d) Biomechanics - the study of structural, functional and mechanical aspects of human motion. It is concerned mainly with external forces of either a static or dynamic nature, dealing with human movement.

e) Fixation - The state whereby an articulation has become fully or partially immobilized in a certain position, restricting physiological movement.

f) Joint manipulation - A manual procedure involving directed thrust to move a joint past the physiological range of motion, without exceeding the anatomical limit.

g) Joint mobilization - A manual procedure without thrust, during which a joint normally remains within its physiological range of motion.

h) Neuro-musculoskeletal - Pertaining to the musculoskeletal and nervous systems in relation to disorders that manifest themselves in both the musculoskeletal and nervous systems, including disorders of a biomechanical or functional nature.

i) Palpation - (1) The act of feeling with the hands. (2) The application of variable manual pressure through the surface of the body for the purpose of determining the shape, size, consistency, position, inherent motility and health of the tissues beneath.

j) Spinal manipulative procedures - includes all procedures where the hands or mechanical devices are used to mobilize, adjust, manipulate, apply traction, massage, stimulate or otherwise influence the spine and para-spinal tissues with the aim of influencing the chiropractic health care consumer ™s health.

k) Subluxation - A lesion or dysfunction in a joint or motion segment in which alignment, movement, integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity. This definition is different from the current medical definition, in which subluxation is a significant structural displacement, and therefore a visible in static imaging studies.

l) Subluxation complex (vertebral) - A theoretical model and description of the motion segment dysfunction, which incorporates the interaction of pathological changes in nerve, muscle, ligamentous, vascular and connective tissue.

m) Thrust - The sudden manual application of a controlled directional force upon a suitable part of the chiropractic health care consumer, the delivery of which effects and adjustment.

n) Assessment - The systematic collection and interpretation of information based on chiropractic principles.

o) National Certification - Process of issuing certificates requiring education and training that assures the competency of practitioners and trainers, administered by PITAHC and other PITAHC accredited institutions.

p) National Accreditation - Process of issuing certificates to training programs, centers and clinics.

q) Code of Ethics - a summary of the standards by which chiropractors agree to conduct their practice and is a declaration of the general principles of acceptable, ethical, professional behavior.

RULE II
  The National Certification of Chiropractors

Section 1. National Certification Committee for Chiropractic. For the purpose of certifying chiropractors, the PITAHC Director General shall invite active Filipino Practitioners in the field of Chiropractic, hereinafter referred to as National Certification Committee for Chiropractic. The invitation is valid only for the period indicated herein, renewable at the option of PITAHC Director General.

a. Composition

The Committee shall be composed of the following:

PITAHC Director General - Ex-officio Chairman

Representatives of the following sectors: 

- Three (3) duly-licensed practicing Chiropractors, as defined in these Rules;
- One (1) Medical Doctor preferably from the Philippine Medical Association (PMA); and
- One (1) Educator preferably from the Commission on Higher Education (CHED)

The five (5) members representing the above mentioned sectors shall be appointed by the PITAHC Director General. Of the appointed members, the first three (3) members shall have a term of three (3) years while the remaining two (2) members shall have a term of two (2) years, renewable.

All chiropractors recommended to the National Certification Committee for Chiropractic must be PITAHC duly-certified Filipino Chiropractors, a Medical Doctor and an educator practicing in the Philippines, of good moral character and have not violated ethical standards of the profession.

b. Quorum and Vote

Actions taken by the National Certification Committee for Chiropractic should be by a majority vote of the five (5) representatives from the identified sectors above, in a meeting duly called for the purposes, attended by a majority of members (3 of 5 representatives), and are subject to PITAHC approval. The PITAHC Director General shall cast his vote in the event of a tie among the sectoral representatives-members in a meeting duly called for said purposes, there being a quorum.

c. The PITAHC Advocacy and Training Division Chief and Standard and Accreditation Division Chief shall serve as permanent representatives.

d. The Standard and Accreditation Division shall serve as Committee Secretariat.

Section 2. Duties and Functions of the Committee

a. Develop and maintain the assessments based on the competency standards and code of ethics for Chiropractic;
b. Formulate, review and recommend policies to PITAHC relating to chiropractic education and practice;
c. Recommend and advice PITAHC on issues pertaining to the certification of practice, including, but not limited to, the issuance of and administration of chiropractic certification and administration of licensure;
d. Review and approve Continuing Education course for Chiropractors;
e. Accredit training programs, centers, schools and clinics for chiropractic;
f. Administer the national certification assessments for chiropractic competence standard;
g. Certify practitioners;
h. Revoke certification/accreditation of practitioners, training centers, schools, and clinics for chiropractic;
i. Safeguard public trust by upholding the PITAHC Code of Ethics for Chiropractors;
j. Review and approve research proposals on chiropractic and recommend to PITAHC for approval and/or funding.

The National Certification Committee for Chiropractic may organize sub-committees to pursue specific functions on accreditation, development of standard and guidelines of chiropractic education, licensure certification and other specific functions as may be deemed necessary to further develop and enhance the profession.

A Technical Working Group (TWG) on Education will be convened to work out the curriculum for chiropractic.

RULE III
  The National Certification of Chiropractics

Section 1. National Certification Educational and Technical Qualifications

A. No person shall engage in the practice of chiropractic in the Philippines unless he/she is:

- Filipino citizen;
- At least twenty-one (21) years of age
- Has completed the prescribed chiropractic course herein in a learning institution accredited by PITAHC;
- Satisfactorily passed the corresponding chiropractic certification examination; and
- A holder of a valid Certificate of Registration duly issued to him/her by PITAHC in cooperation with the National Certification Committee for Chiropractic

B. The chiropractic course referred to in the preceding paragraph refers to the following categories:

- A full-time bachelor ™s degree in health sciences, majoring in chiropractic, completed in an accredited learning institutions;
- Graduate school level for those who have completed medicine or health related courses such as nursing, pharmacy, nutrition, physical therapy leading towards doctorate in chiropractic;
- for holders of chiropractic degree in other countries, they shall be subjected for review with an equivalency panel to align courses to the Philippine curriculum.

The said education qualifications are subject to the minimum standard requirements set by the Commission on Higher Education (CHED).

1. Basic science components

Recognized programs either require essentials basic science components as prerequisites, or included necessary units of chemistry, physics and biology within the first-year curriculum.

2. Preclinical science components

The pre-clinical science components within chiropractic programmes generally include: anatomy, physiology, biochemistry, pathology, microbiology, pharmacology and toxicology, psychology, dietetics and nutrition, and public health.

3. Clinical science components

Clinical science components should include or cover: history-talking skills, and physical examination.

4. Chiropractic science and additional subject

These generally include:

- applied neurology and applied orthopedics;
- clinical biomechanics, including, specific chiropractic and biomechanics;
- chiropractic health care consumer assessment by methods such as:
- gait and postural analysis;
- static and motion palpation of joints and bony structures;
- assessment of soft tissue tone and function;
- compliance with existing laws and regulation on diagnostic imaging and analysis;
- history, principles and health care philosophy pertinent to chiropractic;
- ethics and jurisprudence pertaining to the practice of chiropractic;
- background studies of traditional medicine and complementary/alternative healthcare.

4. Chiropractic health care consumer management interventions

Including:

- manual procedures, particularly spinal adjustment, spinal manipulation, other joint manipulation, joint mobilization, soft-tissue and reflex techniques;
- exercise, rehabilitative programs and other forms of active care;
- psychosocial aspects of chiropractic health care consumer management;
- chiropractic health care consumer education on spinal health, posture, nutrition and other lifestyle modifications;
- emergency treatment and acute pain management procedures as indicated;
- other supportive measures, which may include the use of back supports and orthotics;
- recognition of contraindications and risk management procedures, the limitations of chiropractic care, and of the need for protocols relating to referral to other health professionals.

6. Documentation and clinical recordkeeping

Including:

- recording of the primary complaints, health history, physical examination, findings, assessment, diagnosis and treatment plan;
- accurate documentation of every chiropractic health care consumer encounter;
- re-examination findings and documentation of any modifications to care plans;
- appreciation of confidentiality and privacy issues;
- consent obligations;
- insurance and legal reporting

7. Research

Including:

- basic research methodology and biostatistics;
- interpretation of evidence-based procedures/protocols and best practice principles;
- an epidemiological approach to clinical record-keeping, encouragement to document particular case studies and participate in field research projects;
- development of a critical-thinking approach in clinical decision-making, the consideration of published papers and relevant clinical guidelines;

C. Learning institution may offer course on chiropractic after securing the necessary accreditation from the CHED and upon submission of the following requirements:

1. Formal authorization from the Commission on Higher Education (CHED) for the operation of a Baccalaureate programs or Doctor on Chiropractic and develop chiropractic education and programs to operate an institution of higher learning;

2. Certification of incorporation/registration with the Securities and Exchange Commission, including the applicant institution ™s most recent Articles of Incorporation, By-Laws, General Information Sheet and Financial Statements, indicating it is incorporated as a non-profit, non-proprietary institution;

3. Proposed curriculum for chiropractic courses which should comply with the requirements prescribed in the Rules;

4. A governing board that includes representation reflecting the public interest and a full time chief administrative officer who is qualified for the position by education and/or experience;

5. Formal resolution taken by its governing board at a legally constituted meeting that commits the institution to follow the Standards, Policies and Procedures for accreditation prescribed by the National Certification Committee for Chiropractic;

6. Publishes statements, available to all interested publics, showing the applicant institution ™s commitment to follow accepted standards of professional ethics, especially with respect to student recruitment and public information; and

7. A written plan, and a description of a functioning process of planning and evaluation, that identifies and integrates future educational, physical and financial development and incorporates procedures for review and improvement.

D. Subject to existing laws, rules and regulations, and in view of the fact that there are limited number of Filipino citizens who may be considered as experts in the field of chiropractic learning institutions may invite and hire services of foreign lecturers recognized internationally as experts in chiropractic to augment their respective teaching personnel, with the approval of the National Certification Committee for Chiropractic and the Department of Labor and Employment;

E. Chiropractors, chiropractic learning institutions and students of chiropractic shall comply with the safety components prescribed by the World Health Organization Guidelines on Basic Training and Safety in Chiropractic, herein appended and integrated as Annex œA .

Section 2. Application Fee. An application fee shall be collected from applicants who have complied with the requirements for national certification assessments. This application fee may be changed anytime upon review of the Committee.

Section 3. Accreditation Fee. An accreditation fee and an additional accreditation certification fee shall be collected based on the national accounting rules and regulation from those applicants who have complied with the requirements or accreditation. The accreditation fee may be changed anytime upon review of PITAHC.

Section 4. Validity of Certificate of Accreditation. A Certificate of Accreditation granted under these guidelines shall be valid for three (3) years thereafter subject to renewal, suspension or cancellation for cause to be determined by PITAHC Committee.

Section 5. Renewal of Accreditation. The Accreditation shall be renewed on or before its date of expiration. A penalty shall be charged based on the national accounting rules and regulation per year for non-renewal by the chiropractors. The penalty fee may be charged anytime upon review of PITAHC.

RULE IV
Transitory Provision

A. Chiropractors who are already practicing in the Philippines at the time of the effectivity of these Rules are exempted from taking the national certification and may simply register as chiropractors with the National Certification Committee for Chiropractic, provided that they are Filipino citizens, at least twenty-one (21) years of age and have been certified by a learning institution recognized by the PITAHC. Provided further, that chiropractors covered by the aforementioned provision must register within thirty (30) days from the date of effectivity of the Rules.

B. Foreign chiropractors who desire to practice chiropractic in the Philippines are required to submit to the National Certification Committee for Chiropractic the following, among others, within ninety (90) days from the date of effectivity of the Rules:

1. Proof that they have met the requirements prescribed by the abovementioned Guidelines for the three (3) categories, completed at accredited learning institutions;

2. Submission of proof of equivalent licensure examination or proof of licensure credentials, from at least one other country where chiropractic is developed and regulated;

Both Filipino and foreign chiropractors who are already practicing and those who desire to practice in the Philippines shall submit a certificate that their practice in the Philippines shall be supervised by a duly-licensed Filipino chiropractic for a period of six (6) months.

The National Certification Committee for Chiropractic is authorized to review requirements for foreign chiropractors to prove their credentials and competence.

C. PITAHC shall appoint the members of the National Certification Committee for Chiropractic within fifteen (15) days from the date of effectivity of these Rules. Provided that, until PITAHC has appointed said members of the National Certification Committee for Chiropractic, the Ad Hoc Committee for Chiropractic (AHCC) shall exercise the duties and functions of the National Certification Committee for Chiropractic, as provided herein. Provided further that, the AHCC shall cease exercising the duties and functions of the National Certification Committee for Chiropractic immediately after the members of said Committee have been appointed by the PITAHC.

Section 1. Effectivity. The aforementioned APPROVED Guidelines shall take effect fifteen (15) days after publication in the Official Gazette or in at least two (2) newspapers of general circulation. All issuances inconsistent with the provisions of this PITAHC Circular are hereby suspended or amended.

(SGD.) JUVENCIO F. ORDONA, MD
  PITAHC Director-General