21 NCAC 10 .0213 CERTIFIED CHIROPRACTIC ASSISTANTS

(a) Designation. The Board shall classify Certified Chiropractic Assistants as follows:

(1) Level 1 – Clinical

(2) Level 2 – X-ray

For purposes of this Rule, a Certified Chiropractic Assistant – Level 1 is the same as a "chiropractic clinical assistant" as defined in G.S. 90-143.4(a). For purposes of this Rule, a Certified Chiropractic Assistant – Level 2 is the same as a "diagnostic imaging technician" as defined in G.S. 90-143.2 and may be referred to as a "radiologic technologist", "X-ray tech", and "X-ray technician."

(b) Application Procedure. Anyone seeking to be certified as a Chiropractic Assistant shall submit an application found on the Board's website at https://ncchiroboard.com. All applicants shall:

(1) Be at least 18 years of age;

(2) Demonstrate that he or she graduated from high school or the equivalent;

(3) Submit an application fee of thirty-five dollars ($35.00); and

(4) Submit an application containing the following information:

(A) the applicant's name, residential address, phone number, email address, and date of birth;

(B) the applicant's educational history and degree attainment;

(D) whether the applicant now has or has ever had an addiction to, or dependency on, alcohol or other controlled substances;

(E) whether the applicant has ever been convicted of a felony;

(F) whether any criminal charges or criminal investigations, if known, are pending against the applicant;

(G) the email address of a person, known by but not related to the applicant, to complete character reference statements on forms prescribed by the Board; and

(H) a copy of the applicant's government-issued identification document, such as a driver's license or passport.

(1) Education. In addition to the requirements set forth in Paragraph (b) of this Rule, new applicants shall submit evidence of completion of a clinical assistant education program at least 24 hours in length, of which at least 6 hours shall be in-person didactic training with an instructor or instructors who, based on education and experience, are competent to teach the portion of the curriculum they have been assigned. Credit for online coursework shall not exceed 18 hours, and all online coursework shall precede didactic training. The education program shall provide instruction in the five subjects set forth in G.S. 90-143.4(c) to enable its graduates to satisfy all applicable standards of care. To obtain approval of an education program, the program sponsor shall submit to the Board, at least 60 days prior to the proposed starting date, all instructional materials to be used in the program, including a syllabus of the didactic training, and a curriculum vitae for each instructor.

(2) Examination. The proficiency examination for new applicants shall assess both academic knowledge and practical skills acquired through education programs and shall be administered at least four times per year on dates and at locations to be announced by the Board at least 30 days in advance and published on the Board's website at https://ncchiroboard.com. The minimum passing score on the examination is 75 percent.

(d) New Applicants – Level 2.

(1) Education. In addition to the requirements set forth in Paragraphs (b) and (c) of this Rule, new applicants shall complete a radiological technologist education program at least 50 hours in length, of which at least 6 hours shall be in-person didactic training with an instructor or instructors who, based on education and experience, are competent to teach the portion of the curriculum they have been assigned, and completion of the practical requirement as set forth in Subparagraph (d)(2) of this Rule. The education program shall provide instruction in the five subjects set forth in G.S. 90-143.2 to enable its graduates to satisfy all applicable standards of care governing the production of X-rays. To obtain approval of an education program, the program sponsor shall submit to the Board, at least 60 days prior to the proposed starting date, all instructional materials to be used in the program, including a syllabus of the didactic training and a curriculum vitae for each instructor. Any person registered as "active" with the American Chiropractic Registry of Radiologic Technologists shall be deemed to have satisfied the educational requirements of this Paragraph.

(2) Practical Requirement. Upon completion of the training set forth in Subparagraph (d)(1) of this Rule, a person desiring certification as a Certified Chiropractic Assistant – Level 2 shall undergo a Practical Examination within six months of completing the written examination required in Paragraph (c)(2) of this Rule, whereby the person is evaluated by his or her program sponsor on the following competencies while performing x-ray examinations under the in-person observation of a sponsor for four different patients:

(A) Image quality;

(B) Marking sides of the body;

(D) Tube/focal film distance;

(E) Bucky/tube alignment;

(F) Patient positioning;

(G) Gonad shielding;

(H) Ability to name additional views in the series;

(I) Collimation;

(J) Anatomy viewed; and

(K) Technique calculated for measurement of patient.

(3) The person must complete and score at least 64 total points on each of the Thoracic Spine, Lumbar Spine, and Cervical Spine Practical Examinations. The person shall submit written documentation of the Practical evaluation on a form prescribed by the Board that is available on the Board's website at https://ncchiroboard.com/certified-chiropractic-assistant-level-2-xray/. The person completing the Practical evaluation shall provide on the form the following information:

(A) The name and Certified Chiropractic Assistant number of the candidate;

(B) The date of the evaluation;

(D) The name and address of the sponsoring doctor's office;

(E) The signatures of the sponsoring doctor and the candidate; and

(F) Scoring of the candidate's competencies for the criteria set forth in Subparagraph (d)(2)(A) through (K) of this Rule.

(4) Examination. The competency examination shall be administered at least three times per year. The Board shall publish on its website, https://ncchiroboard.com, the date, time, and location of the examination at least 30 days in advance. The minimum passing score is 75 percent.

(e) Reciprocity Applicants. A "reciprocity applicant" means an applicant who is currently certified or registered as a clinical assistant or X-ray technician in another state whose requirements for certification or registration are substantially similar to or more stringent than the requirements for certification in North Carolina. A reciprocity applicant shall submit a copy of the applicant's current certification or registration as a clinical assistant in a state with which North Carolina reciprocates and shall also submit written confirmation from the state's certifying authority or registrar that the applicant is in good standing in that state. Applicants for reciprocity shall pay the application fee set forth in Rule .0803(a)(1) of this Chapter.

(f) Certification Expiration and Renewal. Starting with certifications issued or renewed on or after July 1, 2022, a certificate of competency shall expire on June 30^th of the second year following the year in which it was issued unless otherwise renewed. A Level 1 certificate holder seeking to renew shall submit evidence that the applicant has completed six hours of Board-approved continuing education. A Level 2 certificate holder shall complete six hours of education applicable to a Level 1 renewal plus six hours in radiologic technology. A certificate of attendance or completion issued by the course sponsor and filed with the Board shall constitute prima facie evidence that the applicant has completed the number of hours recited in the certificate. The applicant shall pay to the Board a renewal fee in the amount of fifty dollars ($50.00).

(g) Lapsed Certificates. If a certificate of competency has lapsed due to non-renewal and the lapse does not exceed 60 days, the certificate holder may obtain reinstatement by making up the accrued deficiency in continuing education. If the lapse is greater than 60 days, no make-up continuing education shall be required, but the certificate holder shall re-take and pass the proficiency examination for new applicants. Regardless of the length of lapse, a certificate holder seeking reinstatement shall pay the renewal fee set forth in Paragraph (f) of this Rule.

(h) Exemptions. Graduates of accredited chiropractic colleges and students enrolled in accredited chiropractic colleges who are serving college-sponsored preceptorships in North Carolina are deemed by the Board to have satisfied all requirements imposed by this Rule and shall be deemed competent to perform the duties of a clinical assistant. Any person who qualifies for exemption and who works as a clinical assistant in this state for more than 180 days shall submit the application pursuant to this Rule and note the claim of exempt status. Exempt persons shall not be required to pay a certification fee. For the purposes of this Rule, "accredited" shall mean colleges accredited by the Council on Chiropractic Education.

(i) Displaying Certificate. The holder of a Level 1 certificate issued pursuant to this Rule shall display the certificate in the chiropractic clinic in which the holder is employed in a location where the certificate may be viewed by patients. The holder of a Level 2 certificate issued pursuant to this Rule shall display the certificate in the x-ray room of the chiropractic clinic in which the holder is employed in a location where the certificate may be viewed by patients.

History Note: Authority G.S. 90-142; 90-143.2; 90-143.4; 90-154.3;

Eff. July 1, 2014;

Amended Eff. April 1, 2018;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019;

Amended Eff. January 1, 2022; January 1, 2020;

Readopted Eff. April 1, 2026.