TERMS, CONDITIONS AND LIMITATIONS

General Certificate of Registration

The conditions imposed on a General Certificate of Registration in regulations areⁱ:

1. Prescribed Procedures Regulation (s. 49(1))
   • It is a condition that a member holding a General Certification of Registration does not perform an advanced procedure unless they have successfully completed a certification process or program approved by the CRTO’s Registration Committee within two years prior to the procedure being performed.
2. Prescribed Substances Regulation (s. 49.1)
   • A member holding a General Certificate of Registration while engaging in the practice of Respiratory Therapy, is authorized to administer therapeutic oxygen by inhalation under Authorized Act # 5 providing there are no terms, conditions and limitations prohibiting it.
3. Controlled Acts Regulation (s. 14)
   • Under the Controlled Acts Regulation, a member holding a General Certificate of Regulation is authorized to perform a tracheostomy tube change for an established stoma and/or for a fresh stoma.

Graduate Certificate of Registration

The conditions imposed on a Graduate Certificate of Registration in regulations are:

1. Registration Regulation (s. 60(1))
   • If a member is working in Respiratory Therapy, they must advise all employers of any terms, conditions and limitations that apply to their Graduate Certificate of Registration;
   • A member holding a Graduate Certificate of Registration can only perform a controlled act, authorized to the profession, under general supervision with a member of the CRTO that the graduate member has reasonable grounds to believe is authorized to perform the controlled act, is personally competent to do so, and who is available to be personally present at the site where the authorized act is performed on ten minutes notice; and
   • A member holding a Graduate Certificate of Registration cannot delegate a controlled actⁱⁱ.
2. Prescribed Procedures Regulation (s. 49(2))
   • A member holding a Graduate Certificate of Registration cannot perform an advanced prescribed procedure below the dermis.
3. Prescribed Substances Regulation (s. 49.1(2))
   • A member holding a Graduate Certificate of Registration cannot administer a prescribed substance by inhalation while engaging in the practice of Respiratory Therapy.
4. Controlled Acts Regulation (s. 14)
   • A member holding a Graduate Certificate of Registration may perform a tracheostomy tube change for a stoma that is more than 24 hours old.
   • A member holding a Graduate Certificate of Registration cannot perform a tracheostomy tube change for a stoma that is less than 24 hours old.

Please note: A Graduate Certificate expires 18 months after its initial date of issue under section 60 (2) of the Registration Regulation.

Limited Certificate of Registration

The conditions imposed on a Limited Certificate of Registration in regulations are:

1. Prescribed Procedures Regulation (s. 49(3))
   • A member holding a Limited Certificate of Registration cannot perform an advanced prescribed procedure.
   • A member holding a Limited Certificate of Registration cannot perform a basic prescribed procedure unless the member is permitted to perform the procedure by the terms and conditions of their certificate of registration.
2. Prescribed Substances Regulation (s. 49.1(2))
   • A member holding a Limited Certificate of Registration cannot administer a prescribed substance by inhalation while engaging in the practice of Respiratory Therapy.
3. Controlled Acts Regulation (s. 14)
   • A member holding a Limited Certificate of Registration may perform a tracheostomy tube change for a stoma that is more than 24 hours old if the procedure is permitted by the terms, conditions and limitations of their certificate or registration.
   • A member holding a Limited Certificate of Registration cannot perform a tracheostomy tube change for a stoma that is less than 24 hours old.

Inactive Certificate of Registration

The conditions imposed on an Inactive Certificate of Registration in regulations are:

1. Registration Regulation (s. 63)
   • A member holding an Inactive Certificate of Registration cannot engage in direct patient care, use any title or designation listed in the Table of section 67, supervise the practice of the profession, or make any claim or representation to having any competence in the profession.

ⁱ The following controlled acts authorized to RTs require additional authorizing mechanisms such as direct orders or medical directive:

Under the RTA:

1. Performing a prescribed procedure below the dermis.
2. Intubation beyond the point in the nasal passages where they normally narrow or beyond the larynx.

4. Administering a substance by injection or inhalation.

Under the Controlled Acts Regulation:

Performing a tracheostomy tube change for an established stoma and/or for a fresh stoma

ⁱⁱ It is the College’s position that members who cannot delegate a controlled act, cannot accept delegation for a controlled act.

Application for Change

A Member may apply to the Registration Committee for an order directing the Registrar to remove or modify any term, condition or limitation imposed on the certificate of registration because of a registration proceeding.

Applications to change terms, conditions and limitations that are made within six (6) months of the original TCL’s order date will be reviewed by the Registrar. If the Registrar believes that there is substantial evidence to support the Member’s application (e.g., the Member has undergone appropriate re-training and that their competence has been assessed), the Registrar may refer the application to a panel of the Registration Committee for review.

Once a decision has been made on an application under this section, the applicant may not make a new application within six months without the approval of the Registrar.

Submission

In addition to the Application for Change to Terms, Conditions, and Limitations, the Member should also provide evidence of competence in performing a particular activity, this may include:

• A letter from a supervisor;
• A detailed list of activities performed under supervision, signed by the supervising health care professional(s);
• Evidence that the Member took upgrading/refresher courses.

Review and Decision of the Registration Committee

Once an application to change terms, conditions and limitations have been referred to the Registration Committee for consideration CRTO staff will notify the Member of the Panel review date. The Panel of the Registration Committee will review the documents provided and decisions may include:

• Remove the TCLs imposed on the Certificate of Registration
• Revise the TCLs imposed on the Certificate of Registration
• Request more information from the Member
• Refuse the application

• Application to Change Terms, Conditions, and Limitations
• Guide for Terms, Conditions, and Limitations (TCLs) imposed by the Registration Committee
• Registration and Use of Title Professional Practice Guideline
• Interpretation of Authorized Acts

Telephone: 416-591-7800
Toll-Free (in Ontario): 1-800-261-0528
General Email: questions@crto.on.ca