(1) A naturopathic physician must establish an affiliation relationship with a colon hydrotherapist to allow the colon hydrotherapist to perform colon hydrotherapy on a patient of the naturopathic physician. Such affiliation relationships must be registered with the board on forms provided by the board and will remain in effect until rescinded by either practitioner.

(2) A naturopathic physician who has a registered affiliation relationship with a colon hydrotherapist and desires to terminate such relationship must provide a minimum of 60 days' notice to the colon hydrotherapist prior to submitting documentation to the board rescinding that relationship. If a colon hydrotherapist employee or naturopathic physician employee within a practice is terminated from employment, then any affiliation relationship with that terminated employee is immediately suspended and rescission is effective once documentation is submitted to the board.

(3) A naturopathic physician may enter into registered affiliation relationships with up to a maximum of 20 colon hydrotherapists but may petition the board for a waiver of this limit.

(4) Affiliation relationships must be fully documented, signed by both practitioners with copies maintained by each practitioner, and available upon request by the board or its designee. Such affiliation relationship documentation must include, at a minimum:

(a) Communication of a patient's plan of care to include the methods and process for shared documentation of treatment;

(b) Standards for patient referral, to include an expiration date of the referral or the total number of colon hydrotherapy treatments to be provided within a specified time frame. Unless otherwise stated, such referral shall not exceed 24 treatments within six months;

(c) Policy and procedures for transfer of patient care in the event a higher level is indicated;

(d) Acknowledgment that contraindications for a patient prohibit performing colon hydrotherapy including, but not limited to:

(i) Gastrointestinal cancer;

(ii) Acute or severe abdominal pain;

(iii) Gastrointestinal bleed within the past six weeks;

(iv) Surgery within the previous six weeks of the following types:

(A) Abdominal;

(B) Gastrointestinal;

(C) Colon;

(v) History of gastrointestinal hemorrhage or perforation;

(vi) Complicated abdominal hernia;

(vii) Severe anemia;

(viii) Acute diverticulitis;

(ix) Severe or painful hemorrhoids;

(x) Severe or painful fissures or fistula;

(xi) Acute ulcerative colitis;

(xii) Acute Crohn's disease;

(xiii) Recent myocardial infarction;

(xiv) Congestive heart failure;

(xv) Uncontrolled hypertension;

(xvi) Vascular or aortic aneurysm;

(xvii) Kidney failure or renal insufficiency;

(xviii) Acute cirrhosis; and

(xix) Pregnancy that is:

(A) First trimester;

(B) Third trimester;

(C) Complicated; or

(D) High risk; and

(e) A plan for inspection and maintenance of the colon hydrotherapy equipment, which must be registered FDA equipment and utilize disposable rectal nozzles or speculae. However, if the equipment utilizes reusable materials, such materials must be cleaned and sterilized within manufacturer's specifications. Any disposable materials shall not be reused or repurposed.