FAQs about ethics

The Occupational Therapy Code of Ethics was last updated and adopted by the American Occupational Therapy Association’s (AOTA’s) Representative Assembly (RA) in 2020. As an official document, revisions to the Code are considered on a 5-year review cycle with public comment from members and key stakeholders considered as part of the review process.

Yes. Members can access ethics advisory opinions on topics of current interest to assist them in applying the Code to professional issues.

The Code is designed to reflect the dynamic nature of the profession, the evolving health care environment, and emerging technologies that can present potential ethical concerns in practice, research, education, and policy. The document relates to actions taken by occupational therapy personnel in any professional role. The Code is intended to guide professional conduct, but occupational therapy personnel should pay careful attention to how personal interactions and choices outside the workplace may affect public perception of the profession and clients whom they serve. Occupational therapy personnel should be aware that the public may not differentiate private from professional roles, particularly when professional credentials or other forms of identification related to occupational therapy are used. 

If the decision is made to file a complaint, there are several options, depending on the nature of the incident and the setting. Unethical conduct by an individual occupational therapist or occupational therapy assistant can be reported to:

• State licensure board
• AOTA’s Ethics Commission
• National Board for the Certification of Occupational Therapy (NBCOT®).

AOTA is a voluntary membership organization and is only permitted to handle ethics complaints against occupational therapists; occupational therapy assistants; or students who are, or were, AOTA members at the time of the alleged misconduct. 

NBCOT is a private, nongovernmental credentialing agency that provides initial certification and recertification for occupational therapists and occupational therapy assistants. NBCOT has the authority to investigate complaints and may take action where there is clear evidence that a present or future certificant has violated its Code of Conduct.  

SRBs are legal entities that have jurisdiction over individuals licensed to practice in that state. Each state has its own procedures for filing a complaint. 

A complaint may be filed simultaneously with more than one of these organizations, if appropriate.

The specific process for AOTA is detailed in the Enforcement Procedures. The Ethics Commission accepts written complaints about issues that have occurred during the past 7 years.

Unethical conduct by a professional of another discipline can be reported to their state licensure board, professional association, or credentialing body. Medicare fraud (which is a legal issue) can be reported to the Office of the Inspector General (OIG), which handles Medicare and Medicaid fraud and abuse prevention, detection, and reporting. Contact the OIG National Hotline at 800-HHS-TIPS (800-447-8477).

Depending on the situation, you can also report improper practices in your facility to the state survey agency that licenses the facility:

• To file a complaint with state agency
• State-by-state agency contacts.

In addition, the facility or organization may have an ombudsman or compliance hotline for reporting.

Below are links to other professions’ websites:

American Physical Therapy Association

American Speech-Language-Hearing Association

American Psychological Association

American Medical Association

The Ethics Commission accepts reports of ethics violations from a variety of sources, including students. Although a student may find it difficult to report a faculty member or clinical instructor because of the innate power imbalance in the relationship, they can look to the Code for guidance. A student should proceed prudently and use critical reflection to determine whether an ethics violation did occur, and what actions are available and most appropriate. Students should refer to policies for filing a grievance within their respective department and/or college or university if the conduct of concern involves a faculty or staff member. If the potential offense relates to conduct by the clinical instructor in the facility, contact the academic fieldwork coordinator (AFWC). If these strategies are ineffective and the issue remains unresolved, the student may file a complaint with the Ethics Commission.

The provider–patient relationship entails special obligations to maintain confidentiality. Based on the principles established in the Code, confidentiality is a duty of occupational therapy personnel and a right of the patient. Subject to federal mandates (HIPAA) and state laws (practice acts), confidentiality may be breached or overridden when the safety of a patient is at risk or there is an ethical obligation to prevent foreseeable harm to self or others. Other exceptions to confidentiality include mandatory reporting of suspected abuse, information required by law during court proceedings, and documentation of communicable diseases to public health agencies.

Information about a student should be shared only for the purposes of protecting client, student, and fieldwork educator safety, and supporting the student’s successful completion of fieldwork requirements. In addition, when sharing student information, you need to ensure that the specific information shared is allowable under HIPAA (1996) and FERPA (1974) privacy and confidentiality statutes.

For additional information about ethical issues related to fieldwork education, see the ethics advisory opinion on For additional information about ethical issues related to fieldwork education, see the ethics advisory opinion on Promoting Ethically Sound Practices in Occupational Therapy Fieldwork Education.

Occupational therapy assistants work under the supervision of an occupational therapist. Be sure to check your state regulations for specific language related to the occupational therapy assistant scope of practice and supervision requirements. In addition, the AOTA official document, Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services provides guidance about appropriate delegation of aspects of evaluation and intervention. Per this document, the occupational therapist directs the initial evaluation process. However, the occupational therapy assistant may, if directed by the occupational therapist, and deemed competent, perform designated assessments to contribute to the evaluation, but they may not interpret data. Interpreting assessment results and the overall evaluation is the responsibility of the occupational therapist. Also, check state law related to language about occupational therapy assistants contributing to an evaluation.

For more information about contributing to the evaluation process, see the advisory opinion OT/OTA Partnerships: Achieving High Ethical Standards in a Challenging Health Care Environment.

As outlined in the AOTA document Physical Agent Modalities: A Position Paper, before using and recommending PAMs for clients as a treatment modality, the supervising occupational therapist must meet qualifications and be competent in PAMs prior to delegating any of the modalities. PAMs include, but are not limited to, superficial thermal agents, deep thermal agents, electrotherapeutic agents, and mechanical devices. If state regulations permit, then delegating occupational therapy assistants to use PAMs is permitted. The occupational therapy assistant must also be adequately trained and demonstrate competency to use the recommended modalities. Occupational therapy practitioners should keep records of their PAMs training and demonstrated competency.

Specific language to support this ethical and professional mandate can be found in the position paper: "Certain states have additional regulatory requirements for demonstrating competence beyond entry-level education and for specific types of PAMs. Occupational therapy practitioners need to be aware of and comply with these requirements, which may include, but are not limited to, continuing professional education, institution-specific procedures for ascertaining service competence, and supervised contact hours by a qualified practitioner in the respective state"  (p. 2).

The Code mandates safe and competent practice within the occupational therapy practitioner’s scope of practice. In addition, the Code reinforces that delegated duties must match qualifications and scope of practice and that practitioners must adhere to guidelines and applicable laws related to appropriate supervision.

Refer to the advisory opinion Ethical Issues Around Payment for Services for information related to this issue.

No. If the occupational therapist is providing occupational therapy services, (including biofeedback therapy), the order should be written for occupational therapy and services should be documented and billed as occupational therapy. Individuals should also check the reimbursement guidelines of payers and state regulations regarding scope of practice.

No. Physical, speech, respiratory, and occupational therapies must be provided by individuals who have met specific qualifications by successfully completing their respective academic programs, fieldwork placements, and national certification requirements, and who hold active state licensure (or other required regulation) in their discipline. Professionals are individually licensed, and these licenses are not interchangeable.

This is a question about about fraudulent billing. For a definition of fraud, refer to the Centers for Medicare and Medicaid Services (CMS) website. You should first speak with the parties involved and get the facts. After doing so, if you still feel that fraudulent billing has occurred, speak confidentially to the compliance officer or designated administrator at your place of work about your concerns and options for action. If you are in a state that requires licensure to practice, be sure to speak to the SRB. If you are unable to resolve the situation in the workplace, it is your duty to contact the appropriate authorities (e.g., CMS, state licensure board).

When deciding whether or not engaging in a relationship with a past patient is appropriate, you should review the regulations, if any, put forth by your SRB. Some states have defined time frames within which relationships with former clients are acceptable; others have declared all such relationships unethical. The Code discusses such relationships under Section 2, Therapeutic Relationships. When no legal barriers apply, the prudent practitioner weighs the potential harm to the former patient and considers whether a relationship could be established on “equal footing,” considering the prior client–therapist relationship, the vulnerability of clients, and the power differentials that exist between client and therapist. Further guidance on dating and professional boundaries can be found in the ethics advisory on Professional Boundaries: Where to Draw the Line.

No. The existing family relationship may jeopardize objective, professional judgment and bias in making decisions or recommendations. Maintaining professional boundaries separate from personal relationships is an important ethical tenet.

As an occupational therapy practitioner, you may have access to information that as a family member you might not otherwise know, and because of confidentiality, you would be precluded from sharing the information with other family members. This could create an ethical conflict for you. There is also the possibility that your grandmother might withhold important information that she would have been willing to share with a nonrelative therapist, which could potentially jeopardize treatment decisions and progress.

Ethical issues related to Facebook (or other social media) posts fall into three categories: confidentiality, privacy, and fidelity, or respect for others. Of utmost importance is keeping clients’ protected health information confidential in accordance with HIPAA (1996) regulations. It is important to remember that the privacy of information posted on the Internet should not be expected and is not guaranteed. This includes descriptions that could be linked to clients. Therefore, individuals must exercise prudence to avoid posting information that is illegal or unethical. Finally, posting negative information about others, with or without their knowledge, is unprofessional and disrespectful, and should be avoided. The Code, Section 7 addresses professional civility including use of social media.

For additional information, see the ethics advisory opinion on Ethics and Social Media.

Candidates for AOTA elected and appointed positions must sign an attestation on the nomination form affirming that they have not had a public disciplinary action (censure, probation, suspension or revocation of membership) in the past 3 years. In addition, candidates for an AOTA office must be members of AOTA, so if you received a public sanction of revocation (permanent denial of membership), you are not be eligible to serve as a volunteer.

A criminal record may affect your future ability to enter an educational program, complete required clinical fieldwork, take the NBCOT certification exam, become licensed or regulated to practice, and obtain a job in occupational therapy. Any or all of these activities or entities may require a criminal background check.

You may want to seek information about the NBCOT Early Determination Process related to a previous criminal conviction.

It is also important to contact the licensure board/regulatory agency in the jurisdiction(s) in which you anticipate practicing. Each state, and the District of Columbia and Puerto Rico, has a regulatory contact.

There may be both legal and ethical responsibilities related to medical records.

If you are governed by CMS or any other accrediting agency (e.g., The Joint Commission) you should check the standards of these organizations. You can usually find copies of records management procedures in the medical records or health records office of a facility.

The general legal standard for retaining records is 5 years but may vary by state. However, pediatric records must be retained until 7 years after the age of majority (usually age 18 years, but this can vary by state.) States and individual facilities may have more stringent standards for medical record retention, so be sure to check any relevant regulations or policies. HIPAA privacy regulations require that all medical records, signed consent forms, authorization forms, and other HIPAA-related documentation be retained for a period of 6 years. CMS requires patient records for Medicare beneficiaries to be retained for a period of 5 years (see 42CFR482.24 [b]). Medicaid requirements vary by state.

Laws regarding record retention are passed by the state legislature as well as the federal government. You can search your state’s website to find applicable laws or your state’s Department of Health website. You can also contact a lawyer knowledgeable about federal and state medical record laws.

In addition, the American Health Information Management Association has published recommended record retention standards and created summaries of accreditation agency and federal health record retention requirements.

No. You may only document services that you have personally provided or supervised (e.g., an occupational therapist may co-sign notes for an occupational therapy assistant they supervise if required by state law). Your signature on the documentation attests to the accuracy of the information contained in that note. The Code contains language for occupational therapy personnel about fabricating or falsifying documentation.

The Code states that you should not use any form of communication that is false, fraudulent, or deceptive. If you have billing records or notes that explain the dates and times you saw a particular patient, you can write a note using the current date and explain that the original documentation was lost. You should also indicate that this current note reflects what treatment was rendered based on the records that do exist. If you do not have notes and cannot remember what you did and what type of progress an individual made, then it is unethical to make up something.

First and foremost, you should apply sound clinical reasoning to determine whether providing services using telehealth technology serves the best interest of each individual client (i.e., will the services provided be safe and effective in meeting client goals). You also need to ensure that measures are taken to protect client privacy and confidentiality during the delivery of services (e.g., ensure that technology is secure). If you are providing services to a client in a different state, you have a duty to adhere to required state licensure regulations in both your home state and in the state where services are delivered (if telehealth services are permitted). Finally, you need to ensure that documentation accurately represents services provided and that billing for services meets third-party payer standards and requirements. For additional information about service delivery using telehealth technology, see AOTA’s position paper on Telehealth in Occupational Therapy and the ethics advisory opinion on Telehealth.