Can Physical Therapists Prescribe Medication? Prescribing Rights!

According to the country you live in, your physical therapist may not have the same prescribing rights. Most of the time, physical therapists are not allowed to prescribe medications… but sometimes they can! And in most countries, they have the right to prescribe medical devices such as braces or canes, which can be reimbursed.

In this article, I provide an overview of what a physical therapist (PT) is allowed to prescribe in the United States, United Kingdom, Canada, and France, and how their prescriptions should be written.

All sources at the end of the article.

Happy reading 🙂! And if you have any information to share, corrections to make, or questions, feel free to leave a comment!

What is the prescription right of physical therapists?

I will talk about the situation in the four countries where most of our visitors come from: France, the United States, Canada, and the United Kingdom.

Here is a summary:

Country	Medications	Medical devices
🇫🇷 France	No	Yes, some
🇺🇸 United States	No	Yes, some
🇨🇦 Canada	Not likely	Yes, some
🇬🇧 United Kingdom	Yes, some	Yes, some

Can a dpt prescribe medicine? PT and DPT in United States have the same rights.

In France: PT can prescribe medical devices but no medication

A decree from 2006 sets the conditions for prescription by physical therapists in France. The decree also outlines the medical devices that physical therapists are authorized to prescribe, and the list is provided below. The list has not been updated since 2006, and there is no medication in the list.

For patients to be reimbursed by social security and insurance companies, the prescription by the physical therapist must take place within the framework of a contracted practice. This means that the patient must already have a prescription for physical therapy sessions (except in certain cases: this is called direct access to physical therapy). It is within the scope of this treatment, often prescribed by a physician (physical therapists are not doctors), that physical therapists can independently prescribe medical devices.

French physical therapists can prescribe only medical devices, except if the physician has explicitly stated that the device is not suitable or necessary.

In United States: PT can prescribe medical devices but no medication

In the United States, physical therapists, often referred to as “physical therapists” (PT), have the right to prescribe certain things, but the scope of prescription may vary from one state to another due to specific state laws and regulations.

In Canada: PT can prescribe medication in some provinces?

In Canada, physiotherapists can also prescribe certain medical devices, such as orthotics, splints, or canes, for their patients.

The prescription of medications is included in their scope of prescription in some provinces. This is what is often read on many websites… Without sources! I had a lot of difficulty finding precise sources on this subject, such as:

• In which provinces can physiotherapists prescribe in Canada
• What they can actually prescribe.

I have read and searched for information on all the websites of the professional bodies in different provinces in Canada (Alberta, Ontario, etc.). I have not found anything that clearly states that physiotherapists in Canada can prescribe medications, even with special authorizations!

In United Kingdom: some PT prescribe some medication + medical devices

In the United Kingdom, physiotherapists have been acting in prescription medication under medical approval since 1990 (medications) and 1995 (injections).

Since 2013, the United Kingdom physiotherapists who worked as advanced extended-scope professionals can prescribe medications without medical supervision. Thus, the list of medicines that can be prescribed has been expanded to any licensed medicine from the British National Formulary, for any condition within the practitioner’s area of expertise and competence.

Under that new legal status physios in United Kingdom may prescribe even from a restricted list of controlled drugs according to regional regulations.

⚠️ Not all physiotherapists are authorized to prescribe, and some can only do so in coordination with your doctor. Only 500 physios had the right to prescribe independently in 2018! (source: CSP 2018)

Here are the main medications that physiotherapists in the United Kingdom can prescribe independently without relying on the doctor’s prescription. They’re only pain-killers: opioïdes and benzodiazépines:

• Diazepam by oral administration
• Dihydrocodeine by oral administration
• Fentanyl by transdermal administration
• Lorazepam by oral administration
• Morphine by oral administration or by injection
• Oxycodone by oral administration
• Temazepam by oral administration

The physiotherapists are “independent prescribers”.

Source: hpc-urk.org

How to know if your physiotherapist can prescribe or not? You should ask them if they have gone through the necessary procedures for it! To my knowledge, there is no directory that lists all physiotherapists with the right to prescribe.

PS: in Australia 🇦🇺 and New-Zealand 🇳🇿, PT can also prescribe medication… in some case!

Source: Costa 2017; Chartered Society of Physiotherapy, 2018

Which medical devices can physiotherapists prescribe?

Here is the list of reimbursable medical devices in France AND that can be prescribed by physiotherapists. It is reasonable to assume that the same type of devices may also be relevant in other countries and states, but you will need to check with your local authority (public health insurance/private insurance) to confirm.

• Medical devices intended for patient lifting: patient lifts and hoists such as verticalizers, transfer handles, patient lifts, etc. These devices allow for transfers from the bed to a chair or a commode for individuals who have difficulties performing such transfers with just a walker or human assistance. However, these devices do not prevent caregivers from encouraging the person to participate as much as possible. Homecare physiotherapists may also instruct other healthcare professionals and caregivers on how to use these devices while involving the patient.
• High-resilience foam pressure relief mattresses of the waffle type, which aid in preventing bedsores. Air mattresses or memory foam mattresses, on the other hand, cannot be prescribed by physiotherapists.
• Cushions for pressure sore prevention made of silicone fibers or monobloc foam. Similar to the previous category, memory foam or air cushions should be prescribed by physicians, not physiotherapists. These cushions are often used in wheelchairs or other types of seating, ensuring that their size matches the patient’s needs.
• Bed rails and foot cradles. Bed rails facilitate transfers for individuals who have difficulty sitting at the edge of their bed. Foot cradles are placed at the foot of the bed to prevent bed linens from falling on the feet of bedridden patients. This helps avoid foot drop (loss of extension), especially after lower limb surgery or prolonged bed rest.
• Walking aids: canes, crutches, and walkers. There are different types of canes and walking aids: underarm crutches, forearm crutches, T-handle canes, and Canadian crutches (for people with wrist or forearm fractures). There are also walkers without wheels (frame walkers), walkers with two wheels, or four wheels (rollators). All of these can be prescribed by physiotherapists. The choice of cane or walker depends on the patient’s living situation and needs. For example, here’s an article on walkers and Parkinson’s disease or on fall prevention for the elderly.
• Manually propelled wheelchairs, available for rentals of less than 3 months. They are often prescribed for conditions such as fractures, such as femur fractures, gamma nail insertion, or non-weight-bearing ankle fractures.
• Off-the-shelf posture and/or resting splints. For instance, those used following an ankle sprain, elbow fracture, trochiter fracture, wrist fracture, patella fracture, or tendon disorders. This does not include custom-made splints provided by orthopedic specialists.
• Off-the-shelf orthopedic corrective splints. Unlike the previous category, these splints are not only for resting but also attempt to correct deformations or limitations in joint range of motion. For example, orthopedic splints for correcting hallux valgus.
• Off-the-shelf lumbar support belts and pelvic bandages. More commonly known as lumbar belts or corsets. This does not include posture correctors. It includes foam cervical collars (but not rigid cervical collars).
• Off-the-shelf elastic limb compression bandages and orthoses. This includes class 1, 2, or 3 compression stockings and bandages used typically after lower limb surgery, such as knee prostheses. It also includes bandages and compression garments for the upper limb, especially in cases of lymphedema after breast cancer.
• Perineal skin electrodes or electrodes for neuromuscular electrostimulation for the treatment of urinary incontinence. Note that while physiotherapists can prescribe electrodes, they cannot prescribe electrostimulation devices for rental or purchase, including for perineal rehabilitation.
• Urinary collectors, penile sheaths, pessaries, urinals.
• Cane tips. Made of rubber, they deteriorate in a few months with daily use of T-handle canes or underarm crutches, and therefore need to be replaced to prevent falls and slips.Heel cushions with cutouts and cushioning.
• Aids for respiratory function: peak flow meters, often called peak flow. Prescribed mainly for asthma or other restrictive respiratory conditions.
• Dry or waterproof dressings for immersion in balneotherapy.
• Nicotine replacement therapy (patches, gum, lozenges, inhalers, etc.).

⚠️ All of these devices can be purchased without a prescription (e.g., knee braces, compression stockings, etc.). Whether from a pharmacy, supermarket, or retailer, it doesn’t matter. The only benefit of having a prescription is:

• to benefit from the experience of the prescribing person, who can provide the most suitable device for your case;
• to be reimbursed by public health insurance and private insurance.

Can a physiotherapist prescribe a brace? Yes, braces are part of the list of devices that a physiotherapist can prescribe in France. This allows patients to be reimbursed by public health insurance and private insurance, as if a doctor had prescribed them.

What states & countries can physical therapists order imaging?

I have tried to provide you with as much information as possible about what physiotherapists are allowed to prescribe in terms of medications. Now, I will provide you with information on other questions related to physiotherapist prescriptions: Can they prescribe X-rays? Can a physiotherapist request an MRI? And more.

Country	Xray	MRI scans	CT-Scan
🇫🇷 France	No	No	No
🇺🇸 United States	Yes in some states (like Wisconsin)	Yes in some states (like Colorado)	Yes in some states
🇨🇦 Canada	Yes in some province (like Ontario)	No	No
🇬🇧 United Kingdom	Yes	Yes	Yes

⚠️ Even in countries where some physiotherapists are allowed to order an X-ray or an MRI, they can only do so for conditions they are familiar with and accustomed to treating, such as in the field of traumatology. They cannot, for example, order imaging for a digestive problem.

Can a physical therapist write work restrictions?

Physiotherapists can issue medical certificates for sick leave only in the United-Kingdom.

Country	Sick note/ Fit note / Work restrictions	Participation in sports or vaccination certificates
🇫🇷 France	No	No
🇺🇸 United States	No	No
🇨🇦 Canada	No	No
🇬🇧 United Kingdom	Yes	No

Can physical therapist diagnose?

It all depends on what you mean by “diagnosis.” Physical therapists are trained to identify various musculoskeletal pathologies (like ankle sprain). So, yes, they make physical therapy diagnoses.

However, they do not make medical diagnoses.

For example, they are not authorized to diagnose appendicitis, even though they can recognize warning signs and refer patients to the appropriate healthcare professional.

Can physical therapist give injections?

In United Kingdoms, some physiotherapists are trained to carry out certain injections. In United States and Candada, it depends on the province or state. In France, physiotherapists cannot give injections (except for certain vaccines in certain cases).

What should be included in the standard prescription made by a physiotherapist?

Below are examples of prescriptions written by physical therapists and physiotherapists for various medical devices.

In the United States

In the United States, for a prescription written by a physical therapist to be eligible for reimbursement for an orthopedic brace or support, it should typically include:

1. Patient Information: The prescription should have the patient’s full name, date of birth, and contact information.
2. Diagnosis: The specific medical condition or injury for which the brace is being prescribed should be clearly stated. The diagnosis should be consistent with the physical therapist’s evaluation and assessment.
3. Detailed Description of the Brace: This should include the specific body part it is intended for (e.g., knee, ankle, wrist), the purpose of the brace (e.g., support, immobilization, stabilization), and any specific features or specifications needed.
4. Duration of Use: The prescription should indicate the recommended duration for using the brace.
5. Signature and Credentials: The prescription must be signed by the physical therapist, and their professional credentials should be clearly stated.
6. NPI Number: The National Provider Identifier (NPI) number of the physical therapist should be included on the prescription.
7. Insurance Information: If applicable, the prescription should include information related to the patient’s health insurance, such as the insurance company name, policy number, and any other relevant details.

In the United Kingdom

In the United Kingdom, there are two main types of prescriptions:

• NHS Prescriptions (National Health Service Prescriptions): This type of prescription allows the patient to obtain medications or medical devices for free or at a reduced cost.
• Private Prescriptions: is issued by a physio working in the private healthcare sector. Patients are required to pay the full cost of the prescribed medications or medical devices with a private prescription. These prescriptions can be used for drugs or devices that are not available for free or at a reduced cost under the NHS.

NHS Prescription Form

The following are minimum requirements for a legal NHS prescription from physiotherapist:

1. Date
2. Ink signature by the prescriber
3. Address of the prescriber and an indication of the type of prescriber (physiotherapist)
4. Name and address of the patient.
5. Age for children under 12 years.

Private Prescription Form

Information that must be included:

• signed in ink
• name and workplace address of the physio
• date on which the prescription was signed by you
• after which it can be dispensed
• the profession (=physio)
• name and address of the patient
• age of the patient if they are under 12 years old
• names of the medicines must be written clearly using approved names only. Not use abbreviations in the name of the medicine.

Physio must not use NHS prescribing forms to write private prescriptions.

Source: Chartered Society of Physiotherapy, 2018

In Canada

What should a prescription in Canada contain?

1. prescribing physio’s printed name, signature, and registration number;
2. prescribing physio’s practice address;
3. patient’s name;
4. name of the device
5. quantity;
6. directions for use;
7. full date the prescription was issued (day, month, and year);
8. any additional information required by law (according to province).

In France

This prescription template below includes the information that must be included in the prescription made by physiotherapists:

• Physiotherapist’s identification: name, first name, profession (physiotherapist), RPPS number;
• Address and health insurance number (N°AM)** of the private practice OR the name, address, and FINESS number*** of the facility in case of employment in an institution;
• Patient’s name and first name;
• Date of prescription;
• Handwritten signature of the physiotherapist, mandatory;
• Mention of work-related accident, occupational disease, or long-term exempting condition, if applicable;
• Name of the medical device and quantity.

How long is the prescription made by a physiotherapist valid?

Here are the durations of validity for prescriptions according to the countries. It doesn’t matter whether the prescription is issued by a doctor or a physiotherapist; the duration is the same.

If your physical therapist / physiotherapist adds an expiration date, then the validity period applies accordingly. The durations indicated in the table are therefore the maximum durations, starting from the date on the prescription.

Country	Duration of validity
🇫🇷 France	1 year Source: demarches.interieur.gouv.fr
🇺🇸 United States	On average 12 months, but it can be more or less depending on the states. Idaho: 15 months Illinois:15 months Iowa: 18 months Maine: 15 months South Carolina: 24 months Wyoming: 24 months Source: ama-assn.org
🇨🇦 Canada	Depends on province: can be 100 days (Ontario), 1 year (Alberta), 2 years (British Columbia) Source: see below
🇬🇧 United Kingdom	6 months Source: NHS