After graduation

REGISTRATION TO THE PHYSIOTHERAPY REGISTER OF THE FEDERAZIONE NAZIONALE ORDINI, THE TSRM AND THE PROFESSIONI SANITARIE TECNICHE, DELLA RIABILITAZIONE E DELLA PREVENZIONE (FNO, TSRM AND PSTRP)

Law 3/2018 and the Ministerial Decree of 13 March 2018 reaffirmed that registration in the Register is mandatory for the practice of the profession. This provision, already in force for TSRM and healthcare assistants, is now also in force for the following healthcare professions:
(a) Biomedical Laboratory Health Technician;
(b) Audiometry Technician;
(c) Hearing Aid Technician;
(d) Orthopaedic Technician;
(e) Dietitian;
(f) Neurophysiology Technician;
(g) Cardiovascular Physiopathology and Cardiovascular Perfusion Technician;
(h) Dental Hygienist;
(i) Physiotherapist;
(j) Speech Therapist;
k) Podiatrist;
l) Orthoptist and ophthalmology assistant;
m) Developmental neuro- and psychomotricity therapist;
n) Psychiatric rehabilitation technician;
o) Occupational therapist;
p) Professional educator;
q) Prevention technician in the environment and workplace. 
 
In order to register, the professional must contact the Orders:

• either by connecting to the portal www.tsrm.org and clicking on the heading 'Procedure for the registration of professionals in the registers established by the Ministerial Decree of 13 March 2018', located on the homepage, to access the page within which there is a link to the portal dedicated to registrations;
• or by connecting directly to the link https://iscrizioni.alboweb.net/.

All professionals are required to submit the application for registration as soon as possible, since all the necessary regulatory, procedural and technological elements are available: Article 4 of Law 3/2018, DM 13 March 2018, procedure and portal.
 
It should be noted that practising a health profession without having registered on the relevant register is unlawful, punishable under Article 348 of the Criminal Code, as amended by Article 12 of Law 3/2018.
 
Pursuant to Act 3/2018, the obligation to register shall take effect at 11:00 p.m. on 14 February 2018, i.e. from the entry into force of the Act. The registration obligation starts at midnight on the following 30 June, due to the previous absence of the Ministerial Decree establishing the registers, the procedure and the portal for dematerialised management.
 
For professionals registering for the first time with the local professional associations, fulfilment of the vaccination obligation is a requirement for registration until the expiry of the six month period from 15 December 2021.
INFORMATION MATERIAL MADE AVAILABLE BY THE FNO TSRM AND PSTRP Ministerial Decree of 13 March 2018 Enrolment procedure

 Ministerial Decree of 13 march 2018

Enrolment procedure

Tutorial enrolment 

Law 24/2017 (so-called. Gelli Law) provides, in article 10, for three distinct types of compulsory insurance cover:

• (a) the obligation for healthcare and socio-medical facilities to be provided with insurance cover or similar measures for third-party liability for damage caused by healthcare staff in 'any capacity operating at the facilities', including freelance private practice within the facilities;
• (b) the obligation of insurance for healthcare professionals operating on a freelance basis and therefore with contractual liability towards the patient;
• (c) the obligation of insurance for healthcare professionals operating in any capacity at public and private healthcare and socio-medical facilities for so-called recourse or administrative liability that is triggered in the case of events committed with gross negligence.

 
It is therefore mandatory that all practitioners of one of the health professions belonging to the TSRM and PSTRP orders have a professional liability policy that meets the minimum requirements of Law 24/2017, i.e.:

• a) ten-year retroactivity;
• b) ten-year extra-activity in the event of definitive cessation of activity that includes the retroactive period of coverage, extendable to heirs and not subject to the cancellation clause.

 
The policies contracted by the FNO TSRM and PSTRP meet these requirements and members may adhere to them at the time of enrolment or renewal of enrolment in the Register; members are, however, free to adhere to other policies, provided that they meet similar requirements, where available on the market.

In view of the current risk context, extraordinary and urgent initiatives have been taken in order to adequately deal with possible situations of harm to the community.
 
To Decree-Law No. 44 of 1 April 2021, converted, with amendments, by Law No. 76 of 28 May 2021, the new legislation, which came into force on 27 November, adds that the fulfilment of the vaccination obligation provided for the prevention of SARS-CoV-2 infection includes the primary vaccination cycle and, as of 15 December 2021, the administration of the subsequent booster dose. The minimum interval for booster (booster) dose administration with m-RNA vaccine, (including all subjects vaccinated with a single dose of Janssen vaccine) is five months (150 days) after completion of the primary vaccination cycle, regardless of the vaccine previously used.
 
Modified the lines of verification of the obligation to vaccinate against SARS-CoV-2

The task of control, previously attributed to the Regions and the competent ASLs, is now entrusted to the territorial Orders of the health professions and in particular to the relevant National Federations for registered health professionals.
Without prejudice to the indications that will be provided by the Federation and any explanatory circulars that may be issued by the Ministry of Health, to date, Decree-Law 172, in amending Article 4 of Law 44/2021, textually provides the following.
The Federations, using the National Digital Green Certificate Platform (National Platform-DGC), immediately carry out automated verification of the possession of COVID-19 green certificates proving the SARS-CoV-2 vaccination status of members.

If the anti-SARS CoV-2 vaccination has not been carried out, even with reference to the booster dose following the primary vaccination cycle, the territorially competent Professional Order invites the person concerned to produce, within five (5) days of receipt of the request documentation proving the performance of the vaccination or the omission or postponement thereof (certification of exemption), or the submission of the request for vaccination to be performed within a period not exceeding twenty (20) days from the invitation or, in any case, the non-existence of the conditions for the vaccination obligation.
In the event of the submission of documentation attesting to the request for vaccination, the Order invites the person concerned to submit immediately, and in any case no later than three days after the administration, the certificate attesting to the fulfilment of the vaccination obligation.
Once these time limits have expired, including with regard to the recall dose, it shall notify the competent national federations and, for employees, also the employer.
The act of ascertaining non-compliance with the vaccination obligation is adopted by the territorially competent Order at the end of the above-mentioned verification, is declaratory in nature, not disciplinary, determines the immediate suspension from the exercise of the health professions and is recorded in the relative Professional Register.

The suspension is effective until the communication by the person concerned to the competent territorial Order and, for employees also to the Employer, of the completion of the primary vaccination cycle and, for professionals who have completed the primary vaccination cycle, of the administration of the booster dose and in any case no later than 6 months from 15 December 2021.
Managers of facilities (providing in-patient services on a continuous or day hospitalisation cycle for acute cases, facilities providing specialist assistance services on an out-patient basis (including rehabilitation, instrumental and laboratory diagnostics), and healthcare and social-sanitary facilities that provide services on a residential, continuous or day-care cycle must immediately verify compliance with the aforementioned vaccination obligation (which, in the case of these facilities, as from 15 December is extended to all personnel working in any capacity), including the administration of the booster dose following the primary cycle, in the manner and time frame described above.

In cases where there is no evidence that the SARS-CoV-2 vaccination has been carried out or that the vaccination request has been submitted in the manner established as part of the current vaccination campaign, the person in charge, without delay, shall invite the person concerned, within five (5) days of receipt of the invitation documentation, to produce proof that the vaccination has been carried out or that it has been postponed or exempted (exemption certification), or to submit the request for vaccination to be carried out within a period of not more than twenty days from the invitation, or in any case that the conditions for compulsory vaccination do not exist.

In the event of the submission of documentation attesting to the request for vaccination, the manager invites the person concerned to submit immediately, and in any case no later than three (3) days after the administration, the certificate attesting to the fulfilment of the vaccination obligation.
In the event of failure to submit the aforementioned documentation, the person in charge will ascertain non-compliance with the vaccination obligation and will immediately notify the person concerned in writing.
The finding of non-compliance results in immediate suspension of the right to work, without disciplinary consequences and with the right to continued employment. For the period of suspension, no pay or other remuneration or emolument, however named, is due

.
The suspension shall be effective until notification by the person concerned to the Employer of the commencement and subsequent completion of the primary vaccination cycle or the administration of the booster dose and in any event no later than six (6) months from 15 December 2021.
For professionals registering for the first time with the local professional associations, fulfilment of the vaccination obligation is a requirement for registration until the expiry of the six month period from 15 December 2021.
 
Exemption from SARS CoV-2 vaccination for health professionals

Only in the event of an established health risk, in connection with specific, documented clinical conditions, attested by the general practitioner, is there no such obligation and can the vaccination be omitted or postponed.
The certificates can be issued directly by the vaccination doctors of the Vaccination Services of the Regional Health Service Agencies and Bodies or by the patient's General Practitioners working within the national SARS-CoV-2 vaccination campaign.
For the period during which vaccination is omitted or postponed, the employer will assign employees to tasks which may be different from their usual tasks without any reduction in pay, in order to avoid the risk of spreading SARS-CoV- 2 infection.
In the exercise of freelance activity, for the period during which vaccination is omitted or postponed, in order to contain the risk of contagion, exempted persons shall adopt the preventive hygiene and health measures indicated in the specific safety protocol adopted by decree of the Minister of Health, in agreement with the Ministers of Justice and Labour and Social Policies, by 15 December 2021.
 
Other new features of the decree-law, the duration of the COVID-19 Green Certification

• The COVID-19 Green Certification is valid for nine (9) months from the date of completion of the primary vaccination cycle and is automatically issued to the person concerned, in hard copy or digital format, by the healthcare facility or healthcare professional carrying out the vaccination and at the same time as the vaccination, at the end of the aforementioned cycle.
• When a booster dose is administered following the primary vaccination cycle, the green COVID 19 certificate is valid for nine (9) months from the date of the same administration.
• The green COVID-19 certification referred to in the first sentence is also issued at the same time as the administration of the first dose of vaccine and is valid from the fifteenth day after administration until the date scheduled for the completion of the vaccination cycle, which date must be indicated in the certification when it is issued.
• The green COVID-19 certification referred to in the first sentence is also issued at the same time as a single dose of a vaccine is administered after a previous SARS-CoV-2 infection and is valid from the same
• The certification in question ceases to be valid if, during its period of validity, the person concerned is identified as a confirmed SARS-CoV-2 positive case.

The green COVID-19 certification issued on the basis of the condition of recovery is valid for six months from the date of recovery, and is issued, at the request of the interested party, in paper or digital format, by the facility where the COVID-19 patient was admitted, or, for patients who are not admitted, by general practitioners and by the prevention department of the competent local health authority, and is made available in the electronic health record of the interested party.  This certification ceases to be valid if, during the six-month period of validity, the person concerned is identified as a positive SARS-CoV-2 case. Cure certifications issued prior to the date of entry into force of this decree are valid for six months from the date indicated in the certification, unless the subject is again identified as a confirmed SARS-CoV-2 positive case.

CME is the process by which health professionals keep themselves up-to-date to meet the needs of patients, the requirements of the health service and their own professional development.

Continuing medical education includes the acquisition of new knowledge, skills and attitudes useful for competent and expert practice.

Healthcare professionals have a deontological obligation to put their new knowledge and skills into practice in order to provide quality care. Therefore, taking care of their patients with up-to-date skills, without conflicts of interest, so that they can be good healthcare professionals.
The launch of the National CME Programme in 2002, based on Legislative Decree 502/1992 supplemented by Legislative Decree 229/1999, which had established the obligation of continuing education for healthcare professionals, represented a strong message in the healthcare world. The new phase of CME contains many novelties and presents itself as a tool for designing a modern approach to the development and monitoring of individual competences.

As of 1 January 2008, with the entry into force of Law 244 of 24 December 2007, the administrative management of the CME programme and support to the National Commission for Continuing Education, which until now had been the responsibility of the Ministry of Health, were transferred to the National Agency for Regional Health Services  (Agenas).

The State-Regions Agreement of 1 August 2007, which defines the Reorganisation of the Continuing Medical Education Programme and establishes the new organisation and the new rules for the Governance of the CME system for the three-year period 2008-2010, in fact identifies the Agency as the 'common house' at national level, in which to place the National Commission and the accompanying bodies.
 
The  Co.Ge.A.P.S. (Consorzio Gestione Anagrafica Professioni Sanitarie) is a body that brings together the National Federations of Orders and Colleges and the Associations of Health Professionals participating in the Continuing Medical Education programme.
According to the State-Regions Agreement of 5 November 2009, the Co.Ge.A.P.S. is 'the national body in charge of managing the national and territorial registries, the CME credits attributed to professionals belonging to the Orders, Colleges as well as the respective National Federations and Professional Associations, enabling the latter to perform the relevant functions of certification of the training activities carried out'.
 
The Consortium's activities include:
The management of a centralised registry that, integrated with the local systems of the individual professional orders, sets itself the task of fostering a single, global vision of operations, without circumventing or detracting from the competences legally delegated to each professional order.
An Internet portal, as a reference point for health professionals (registry function for CME purposes) and a tool for better institutional and professional communication. The portal also constitutes an access point for the provision of registry and CME services as it is a system designed for user authentication and profiling to guarantee the reference institutions.
 
The object of Co.Ge.A.P.S. is:

To manage a National database of CME credits acquired by health professionals

To manage a unitary and shared system for the management of training credits acquired by individual health professionals on the basis of the criteria and methods established by the National CME Commission within the framework of the National Continuing Medical Education project

The main means of accessing the National database of CME credits for all public subjects - such as Regions, Health Authorities, Ministry of Health, Age:Na.S, Research Institutions, ASSR, ISS, Universities, ISPESL, CCM - having specific obligations or functions and tasks on the subject

To implement and manage, in coordination with the Ministry of Health and with the Orders, Colleges and Professional Associations of the individual and group training dossier

To engage in operational management, in the application phase, on an equal footing with all the consortium members, including the procurement of funding and technologies for them

To undertake studies and feasibility projects in relation to the individual activities of the consortium members and in favour of the latter in the field of CME
 
Today the Co.Ge.A.P.S.:

• Federazione Nazionale degli Ordini dei Medici Chirururghi e degli Odontoiatri - FNOMCeO
• Federazione degli Ordini dei Farmacisti Italiani - FOFI
• Federazione Nazionale degli Ordini delle Professioni Infermieristiche - FNOPI Federazione Nazionale Ordini Veterinari Italiani - FNOVI
• Consiglio Nazionale Ordine degli Psicologi - CNOP
•  Federazione nazionale degli Ordini della Professione di Ostetrica - FNOPO
• Ordine Nazionale dei Biologi - ONB
• Federazione Nazionale degli Ordini dei Chimici e dei Fisici - FNCF
• Federazione Nazionale degli Ordini dei Tecnici Sanitari di Radiologia Medica, professioni Sanitarie Tecniche, della Riabilitazione e della Prevenzione - FNO TSRM PSTRP
• AGE.NA.S
• Co.Ge.A.P.S.
• Regulation

INTERNATIONAL MOBILITY OF HEALTH CARE PROFESSIONALS

The mobility of professionals within Europe, including those in the health sector, is provided for by EU Directive 2005/36/CE.
 
The directive describes the specific procedural modalities based on the principle of mutual recognition of professional qualifications, in order to allow nationals of a European Union Member State, nationals of countries that are members of the European Economic Area (EEA Area: Norway, Iceland, Liechtenstein) and to nationals of the Swiss Confederation to pursue in another Member State the regulated profession for which they are qualified in their home State.
 
In order to apply the Directive, it is necessary that the profession that one intends to exercise in another Member State is regulated in the host State, i.e. it is a profession the exercise of which is subject, as provided for by legislative, regulatory or administrative provisions, to the possession of certain qualifications and that this profession is equivalent to the profession for which one is qualified in the Member State of obtaining the relevant qualification.
 
The pursuit of a regulated professional activity is only permitted if the professional title is recognised by the State of the host establishment.
 
Italy implemented the aforementioned directive with Legislative Decree No 206 of 9 November 2007, the provisions of which, by virtue of Articles 49 and 50 of Presidential Decree 31 August 1999, are also extended to non-EU citizens in possession of a qualification authorising the exercise of a profession obtained in a non-EU country who intend to practise the profession on a permanent basis in Italy.
 
The same regulations also apply to professional qualifications obtained by non-EU nationals in a Member State or obtained by Italian nationals in a non-EU State.
 
The Ministry of Health is in charge of healthcare qualifications obtained abroad, as provided for in Legislative Decree.206/2007.

Therefore, a professional who wishes to move to Italy to practise a regulated health profession on a permanent basis, based on the qualification obtained in their State of origin must request and obtain recognition of their professional title from the Ministry of Health.
 
If the professional intends to perform a professional healthcare service in Italy on an occasional and temporary basis, they do not have to apply for recognition of their qualification, but must notify the Ministry of Health about the service to be performed, for the free provision of services as provided for by Legislative Decree 206/2007.  
International mobility of health professionals

EUROPEAN PROFESSIONAL CARD - EPC

The European Professional Card (EPC) is an electronic procedure that you can use to have your professional qualifications recognised abroad, in another EU country.

Currently you can only use the procedure to obtain a European Professional Card if you are:
a nurse responsible for general care
a pharmacist
a physiotherapist
a mountain guide
an estate agent.
European Professional Card - EPC - EU European Professional Card - EPC - GOV

DIPLOMA SUPPLEMENT
The Diploma Supplement is a bilingual supplementary certification of the official qualification. This document, developed at the initiative of the European Commission, the Council of Europe and UNESCO-CEPES, describes the nature, level, context, content and status of the studies carried out and completed by the student, with the aim of overcoming the obstacles that prevent the qualifications from applying appropriately in the world of work and from being recognised in the context of national and international mobility by those who intend to continue their studies in European academic institutions.

• Diploma Supplement - UNIPR
• Diploma Supplement - MIUR

RECOGNITION OF SKILLS AND QUALIFICATIONS

• Recognition of skills and qualifications

CERTIFICATE OF LEVEL OF QUALIFICATION

• Certificate of level of qualificatiion

MOBILITÀ INTERNAZIONALE DEGLI OPERATORI SANITARI

This is a massive process of harmonisation of the various European higher education systems, started in 1999, which aims to create a European Higher Education Area and then to promote it worldwide in order to increase its international competitiveness.

The Bologna Process is an impressive process of harmonisation of the various European higher education systems that began on 19 June 1999, when ministers from 29 European countries met in Bologna to sign an important agreement, the Bologna Declaration, which officially launched it.

The main objective of the Bologna Process is the creation of a European Higher Education Area and the promotion of the European higher education system on a global scale in order to increase its international competitiveness. To achieve the harmonisation of European university systems, the Bologna Declaration identified a number of main objectives, the realisation of which was monitored and steered through a series of Follow-Up Conferences held between 1999 and 2010.

Among the objectives that have been achieved and that continue to be developed and pursued are:

• the adoption of a qualification system that is easy to read and compare, also through the implementation of the Diploma Supplement;
• the adoption of a system based on two main cycles, Level 1 and Level 2. Access to the second cycle will require the completion of the first cycle of studies, the duration of which may not be less than three years;
• the consolidation of a system of teaching credits - based on the ECTS system - that can also be acquired in different disciplinary contexts;
• the promotion of mobility (for students, lecturers, researchers and technical-administrative staff) through the removal of obstacles to the full exercise of free movement;
• the promotion of European cooperation in quality assessment;
• the promotion of an indispensable European dimension in higher education: curriculum development, cooperation between university institutions, mobility programmes, integrated curricula, training and research.

THE BOLOGNA PROCESS AND THE EUROPEAN HIGHER EDUCATION AREA

• The Bologna Process and the European Higher Education Area
• Bologna Process
• CONSOLIDATING THE EUROPEAN HIGHER EDUCATION AREA (EHEA) 
• European Higher Education Area and Bologna process