Section 296-17A-6109. Classification 6109.

6109-00 Physicians, surgeons, and medical clinics, N.O.C.

Applies to establishments of licensed practitioners such as physicians and surgeons, and to medical clinics not covered by another classification (N.O.C.) engaged in the practice of general or specialized medicine and surgery. Physicians diagnose and treat a variety of diseases and injuries, order or execute various tests, analyses, and diagnostic images to provide information on a patient's condition, analyze reports and findings of tests and of examination, diagnose conditions, and administer or prescribe treatments and drugs. Physicians may also inoculate and vaccinate patients to immunize them from communicable diseases, or refer patients to a medical specialist or other practitioners for specialized treatment. They may also make house and emergency calls to attend to patients unable to visit the office. Surgeons examine patients to verify necessity of surgery, review reports of patient's general physical condition and medical history, reactions to medications, estimate possible risk to patient, and determine best operational procedure. Surgeons may specialize in a particular type of surgery. This classification includes licensed ophthalmologists who specialize in the diagnosis and treatment of diseases and injuries of the eyes, and examine patients for symptoms indicative of organic or congenital ocular disorders. This classification includes clerical office and sales personnel, as well as other employees engaged in service in the physician's or surgeon's office or in a medical clinic, such as laboratory or X-ray technicians, and nurses.

This classification excludes psychologists and psychiatrists who are to be reported separately in classification 6109-10; optometrists who are to be reported separately in classification 6109-09; radiology and MRI referral clinics which are to be reported separately in classification 6109-17; orthotic referral clinics which are to be reported separately in classification 6109-14; and nutrition, diet, or weight loss clinics which are to be reported separately in classification 6109-12.

6109-01 Dentists and dental clinics

Applies to establishments of licensed dental practitioners and dental clinics engaged in the practice of general or specialized dentistry. Services provided by dental offices or clinics include, but are not limited to, examination of teeth and gums to determine condition, diagnosis of disease, injuries, or malformation, extractions, fillings, root canals, oral surgery, tooth replacement, cleaning, instruction on oral and dental hygiene and preventative care. This classification includes clerical office and sales personnel, as well as other employees engaged in service in the dentist's office such as hygienists, and dental assistants or technicians.

6109-02 Chiropractors, N.O.C.

Applies to establishments of licensed practitioners not covered by another classification (N.O.C.) who are engaged in the practice of chiropractic medicine. Chiropractors diagnose and treat musculoskeletal conditions of the spinal column and extremities to prevent disease and correct abnormalities of the body believed to be caused by interference with the nervous system. They manipulate the spinal column and other extremities to adjust, align, or correct abnormalities caused by neurologic and kinetic articular dysfunction. This classification includes clerical office and sales personnel, as well as other employees engaged in service in the chiropractor's office.

6109-04 Naturopaths, N.O.C.

Applies to establishments of health practitioners not covered by another classification (N.O.C.) who diagnose, treat, and care for patients, using a system of practice that bases treatment of physiological functions and abnormal conditions on natural laws governing the human body, relying on natural remedies such as, but not limited to, acupuncture, sunlight supplemented with diet, and naturopathic corrections and manipulations to treat the sick. This classification includes clerical office and sales personnel, as well as other employees engaged in service in the naturopath's office.

6109-08 Physical therapists, N.O.C.

Applies to establishments of health practitioners not covered by another classification (N.O.C.) who are engaged in the practice of physical therapy, occupational therapy, respiratory therapy, or speech therapy. Therapists treat and rehabilitate people living with physical or mental disabilities or disorders, to develop or restore functions, prevent loss of physical capacities, and maintain optimum performance. Includes occupations utilizing means such as exercise, massage, heat, light, water, electricity, and specific therapeutic apparatus, usually as prescribed by a physician; or participation in medically oriented rehabilitative programs, including educational, occupational, and recreational activities. Physical therapists plan and administer medically prescribed physical therapy treatment for patients suffering from injuries, or muscle, nerve, joint and bone diseases, to restore function, relieve pain, and prevent disability. Occupational therapists plan, organize, and conduct occupational therapy programs to facilitate development and rehabilitation of people living with mental, physical, or emotional disabilities. Respiratory therapists administer respiratory therapy care and life support to patients with deficiencies and abnormalities of the cardiopulmonary system, under the supervision of physicians and by prescription. Speech therapists specialize in diagnosis and treatment of speech and language problems, and engage in scientific study of human communication. This classification includes clerical office and sales personnel, as well as other employees engaged in therapy services and also includes travel to health facilities or other locations to administer therapy services.

6109-09 Optometrists, N.O.C.

Applies to establishments of optometrists not covered by another classification (N.O.C.). Optometrists are licensed practitioners, but do not hold a medical degree. An optometrist in general practice examines patients' eyes to determine the nature and degree of vision problems or eye diseases and prescribes corrective lenses or procedures, performs various tests to determine visual acuity and perception and to diagnose diseases and other abnormalities, such as glaucoma and color blindness. An optometrist may specialize in the type of services provided, such as contact lenses, low vision aids, or vision therapy, or in the treatment of specific groups such as children or elderly patients. This classification includes clerical office and sales personnel, as well as other employees engaged in service in the optometrist's office.

This classification excludes optometrists employed by optical goods stores who are to be reported separately in classification 6308, and ophthalmologists who are to be reported separately in classification 6109-00.

6109-10 Psychologists and psychiatrists, N.O.C.

Applies to establishments of licensed practitioners not covered by another classification (N.O.C.) who are engaged in the diagnoses and treatment of patients with mental, emotional, or behavioral disorders. Psychologists are licensed practitioners who diagnose or evaluate mental and emotional disorders of individuals and administer programs of treatment. They interview patients in clinics, hospitals, prisons, and other institutions, and study medical and social case histories. Psychiatrists are licensed practitioners who diagnose and treat patients with mental, emotional, and behavioral disorders. They organize data obtained from the patient, relatives, and other sources, concerning the patient's family, medical history, and the onset of symptoms, and determine the nature and extent of mental disorder and formulate a treatment program utilizing a variety of psychotherapeutic methods and medications. This classification includes clerical office and sales personnel, as well as other employees engaged in service in the doctor's office.

6109-12 Nutrition, diet, or weight loss clinics, N.O.C.

Applies to establishments engaged as nutrition, diet, or weight loss clinics not covered by another classification (N.O.C.) which provide programs whereby clients may achieve a healthy and permanent weight loss. The programs vary in approaches but most are based on the behavior modification theory, utilizing private counseling or group support meetings and seminars to educate individuals about their eating habits and proper eating patterns. Some programs may sell vitamin supplements or a line of food products to be used by their clients and may publish newsletters or other forms of literature for the benefit of their clients. This classification includes clerical office and sales personnel.

This classification excludes exercise programs which are to be reported separately in the appropriate classification.

6109-13 Childbirth classes

Applies to establishments providing childbirth education for expectant parents. Topics include, but are not limited to, expectations during pregnancy, breathing and relaxing techniques, and massage therapy. Literature and/or movies may be provided in addition to oral instruction. This classification includes clerical office and sales personnel.

6109-14 Orthotic referral clinics

Applies to establishments operating as clinics to provide care to patients with disabling conditions of the limbs and spine by fitting and preparing orthopedic braces under the direction of and in consultation with physicians. Orthotists examine and evaluate the patient's needs in relation to disease and functional loss, and assist in the design of an orthopedic brace. Orthotists select materials, make cast measurements, model modifications and layouts. When the brace is finished, they evaluate it on the patient, make adjustments to ensure correct fit, and instruct the patient in the use of the orthopedic brace. This classification also includes clinics of prosthetists who provide care to patients with partial or total absence of a limb by planning fabrication of, writing specifications for, and fitting the prosthesis under the guidance of and in consultation with a physician. This classification includes clerical office and sales personnel, as well as other employees engaged in service in the referral clinics.

This classification excludes the manufacture of orthopedic braces, splints or prostheses which is to be reported separately in the applicable classification.

6109-15 Midwife services

Applies to establishments engaged in the practice of midwifery. Midwives provide care for women undergoing medically uncomplicated pregnancy and low risk labor and delivery. The delivery may take place in a clinic setting or in the expectant mother's home. This classification includes clerical office and sales personnel.

6109-16 Licensed massage therapy, reflexology, and foot massage services

Applies to establishments of licensed practitioners who are engaged in the practice of massage therapy. Some massage therapists work in conjunction with physicians or sports teams, or at hospitals, rehabilitation facilities or convalescent homes. If a client is referred by a physician, the therapist will review the medical report and in conjunction with the client, will determine the nature of the massage (whether it is for relaxation or to correct or relieve a medical problem) and the modality to be used, such as deep-muscle work, trigger-point therapy, or joint rotation. Establishments providing reflexology and foot massage services are included in this classification. This classification includes clerical office and sales personnel as well as other employees engaged in these services.

This classification excludes massage therapists employed by a health club, gymnasium, sauna, or bath house who are to be reported separately in classification 6204; massage therapists employed by a business classified in 6501-01.

6109-17 Radiology and MRI referral clinics

Applies to establishments of licensed practitioners who are engaged in the practice of radiology and/or magnetic resonance imaging. Radiologists diagnose and treat diseases of the human body using X-ray and radioactive substances. They examine the internal structures and functions of the organ systems and make diagnoses after correlating the X-ray findings with other examinations and tests. They administer radiopaque substances by injection, orally, or as enemas, to render internal structures and organs visible on X-ray films or fluoroscopic screens. Radiologists may employ magnetic resonance imaging technologists to operate magnetic resonance imaging equipment which produces cross-sectional images (photographs) of a patient's body for diagnostic purposes. This classification includes clerical office and sales personnel, as well as other employees engaged in service in the clinics, such as nurses or technologists.

[Statutory Authority: RCW 51.04.020 and 51.16.035. WSR 15-02-060, § 296-17A-6109, filed 1/6/15, effective 7/1/15. WSR 07-01-014, recodified as § 296-17A-6109, filed 12/8/06, effective 12/8/06. Statutory Authority: RCW 51.16.035, 51.04.020. WSR 00-14-052, § 296-17-686, filed 7/1/00, effective 7/1/00. Statutory Authority: RCW 51.16.035. WSR 99-18-068, § 296-17-686, filed 8/31/99, effective 10/1/99; WSR 98-18-042, § 296-17-686, filed 8/28/98, effective 10/1/98. Statutory Authority: RCW 51.04.020(1) and 51.16.035. WSR 94-12-063, § 296-17-686, filed 5/30/94, effective 6/30/94; WSR 93-12-093, § 296-17-686, filed 5/31/93, effective 7/1/93. Statutory Authority: RCW 51.16.035. WSR 87-24-060 (Order 87-26), § 296-17-686, filed 12/1/87, effective 1/1/88; WSR 87-12-032 (Order 87-12), § 296-17-686, filed 5/29/87, effective 7/1/87; WSR 85-24-032 (Order 85-33), § 296-17-686, filed 11/27/85, effective 1/1/86; WSR 85-06-026 (Order 85-7), § 296-17-686, filed 2/28/85, effective 4/1/85; WSR 83-24-017 (Order 83-36), § 296-17-686, filed 11/30/83, effective 1/1/84; WSR 81-24-042 (Order 81-30), § 296-17-686, filed 11/30/81, effective 1/1/82; Order 73-22, § 296-17-686, filed 11/9/73, effective 1/1/74.]

(Effective January 1, 2017.)

WAC 296-17A-6109

Classification 6109.

Medical and health services N.O.C.

Applies to licensed medical practitioners, medical or treatment clinics, and other health practices not providing overnight care or residency. Medical and health services examine, test, diagnose, refer, consult, and treat patients for all types of diseases, conditions, maladies, injuries, syndromes, addictions, and disorders.

Classification 6109 includes:

• All work performed at clinics;

• Employees of a clinic visiting patients at home, or in other care related facilities such as hospitals or nursing homes;

• Clerical office and sales personnel, whether working at a clinic or in a separate business office.

Occupations typically reported in classification 6109 include employment such as:

• Acupuncturists;

• Alternative medicine practitioners;

• Chiropractors;

• Counselors;

• Dental assistants;

• Dental technicians;

• Dentists;

• Dieticians;

• Eyewear technicians;

• Foot massagers;

• Hygienists;

• Laboratory technicians;

• Licensed massage therapists;

• Medical billers;

• Midwives;

• Naturopaths;

• Nurse practitioners;

• Nurses;

• Occupational therapists;

• Ophthalmologists;

• Optometrists;

• Orthotic technicians;

• Pharmacists;

• Phlebotomists;

• Physical therapists;

• Physicians;

• Prosthetic technicians;

• Psychiatrists;

• Psychologists;

• Radiologists;

• Receptionists;

• Reflexologists;

• Respiratory therapists;

• Speech therapists;

• Surgeons;

• X-ray technicians.

Special note: Some organizations such as schools, spas, sports teams, and summer camps may employ medical and health practitioners to provide care to their employees or customers. These medical services are included in the basic classification representing the nature of the organization's business.

Classification 6109 excludes:

• Firms providing medical services treating animals, which are classified in 6107-01;

• Firms providing medical care, therapy, and nursing services whose principal business is treating patients in their homes, which are classified in 6110-00;

• Firms providing in-home personal care and chore services which are classified in 6511;

• Personal care and chore service employees employed by the person being cared for, who are classified in 6510 or 6512, and dieticians and counselors employed by home health care services who meet the standard exception requirements and are classified 6303-21;

• Medical facilities that include overnight acute care, recovery, and rehabilitation, which are classified in 6105, 6120, and 6121;

• Medical facilities providing care in state licensed convalescent and nursing homes, which are classified in 6108-00;

• Long-term residential facilities providing personal care services with less than acute care medical services, which are classified in 6509.

For administrative purposes, classification 6109 is divided into the following subclassification(s):

6109-00 Physicians and medical clinics, N.O.C.

6109-01 Dental clinics

6109-02 Chiropractors

6109-04 Naturopaths

6109-08 Physical, occupational, respiratory, and speech therapists

6109-09 Eye clinics

6109-10 Licensed mental health practitioners; psychologists and psychiatrists

6109-12 Clinics for nutrition, diet, or weight loss

6109-13 Childbirth classes

6109-14 Orthotic and prosthesis clinics

6109-15 Midwife services

6109-16 Licensed massage therapy, reflexology, and nonlicensed massage services

6109-17 Radiology and MRI referral clinics

[Statutory Authority: RCW 51.04.020 and 51.16.035. WSR 16-14-085, § 296-17A-6109, filed 7/5/16, effective 1/1/17; WSR 15-02-060, § 296-17A-6109, filed 1/6/15, effective 7/1/15. WSR 07-01-014, recodified as § 296-17A-6109, filed 12/8/06, effective 12/8/06; WSR 00-14-052, § 296-17-686, filed 7/1/00, effective 7/1/00. Statutory Authority: RCW 51.16.035. WSR 99-18-068, § 296-17-686, filed 8/31/99, effective 10/1/99; WSR 98-18-042, § 296-17-686, filed 8/28/98, effective 10/1/98. Statutory Authority: RCW 51.04.020(1) and 51.16.035. WSR 94-12-063, § 296-17-686, filed 5/30/94, effective 6/30/94; WSR 93-12-093, § 296-17-686, filed 5/31/93, effective 7/1/93. Statutory Authority: RCW 51.16.035. WSR 87-24-060 (Order 87-26), § 296-17-686, filed 12/1/87, effective 1/1/88; WSR 87-12-032 (Order 87-12), § 296-17-686, filed 5/29/87, effective 7/1/87; WSR 85-24-032 (Order 85-33), § 296-17-686, filed 11/27/85, effective 1/1/86; WSR 85-06-026 (Order 85-7), § 296-17-686, filed 2/28/85, effective 4/1/85; WSR 83-24-017 (Order 83-36), § 296-17-686, filed 11/30/83, effective 1/1/84; WSR 81-24-042 (Order 81-30), § 296-17-686, filed 11/30/81, effective 1/1/82; Order 73-22, § 296-17-686, filed 11/9/73, effective 1/1/74.]

RCW 51.04.020 and 51.16.035. WSR 15-02-060, § 296-17A-6109, filed 1/6/15, effective 7/1/15. WSR 07-01-014, recodified as § 296-17A-6109, filed 12/8/06, effective 12/8/06. Statutory Authority: RCW 51.16.035, 51.04.020. WSR 00-14-052, § 296-17-686, filed 7/1/00, effective 7/1/00. Statutory Authority: RCW 51.16.035. WSR 99-18-068, § 296-17-686, filed 8/31/99, effective 10/1/99; WSR 98-18-042, § 296-17-686, filed 8/28/98, effective 10/1/98. Statutory Authority: RCW 51.04.020(1) and 51.16.035. WSR 94-12-063, § 296-17-686, filed 5/30/94, effective 6/30/94; WSR 93-12-093, § 296-17-686, filed 5/31/93, effective 7/1/93. Statutory Authority: RCW 51.16.035. WSR 87-24-060 (Order 87-26), § 296-17-686, filed 12/1/87, effective 1/1/88; WSR 87-12-032 (Order 87-12), § 296-17-686, filed 5/29/87, effective 7/1/87; WSR 85-24-032 (Order 85-33), § 296-17-686, filed 11/27/85, effective 1/1/86; WSR 85-06-026 (Order 85-7), § 296-17-686, filed 2/28/85, effective 4/1/85; WSR 83-24-017 (Order 83-36), § 296-17-686, filed 11/30/83, effective 1/1/84; WSR 81-24-042 (Order 81-30), § 296-17-686, filed 11/30/81, effective 1/1/82; Order 73-22, § 296-17-686, filed 11/9/73, effective 1/1/74.] [Statutory Authority: RCW 51.04.020 and 51.16.035. WSR 16-14-085, § 296-17A-6109, filed 7/5/16, effective 1/1/17; WSR 15-02-060, § 296-17A-6109, filed 1/6/15, effective 7/1/15. WSR 07-01-014, recodified as § 296-17A-6109, filed 12/8/06, effective 12/8/06; WSR 00-14-052, § 296-17-686, filed 7/1/00, effective 7/1/00. Statutory Authority: RCW 51.16.035. WSR 99-18-068, § 296-17-686, filed 8/31/99, effective 10/1/99; WSR 98-18-042, § 296-17-686, filed 8/28/98, effective 10/1/98. Statutory Authority: RCW 51.04.020(1) and 51.16.035. WSR 94-12-063, § 296-17-686, filed 5/30/94, effective 6/30/94; WSR 93-12-093, § 296-17-686, filed 5/31/93, effective 7/1/93. Statutory Authority: RCW 51.16.035. WSR 87-24-060 (Order 87-26), § 296-17-686, filed 12/1/87, effective 1/1/88; WSR 87-12-032 (Order 87-12), § 296-17-686, filed 5/29/87, effective 7/1/87; WSR 85-24-032 (Order 85-33), § 296-17-686, filed 11/27/85, effective 1/1/86; WSR 85-06-026 (Order 85-7), § 296-17-686, filed 2/28/85, effective 4/1/85; WSR 83-24-017 (Order 83-36), § 296-17-686, filed 11/30/83, effective 1/1/84; WSR 81-24-042 (Order 81-30), § 296-17-686, filed 11/30/81, effective 1/1/82; Order 73-22, § 296-17-686, filed 11/9/73, effective 1/1/74.