Common use of Acupuncture treatment Clause in Contracts

Acupuncture treatment. Acupuncture attempts to normalize physiological functions, to modify the perception of pain, and to treat certain diseases and dysfunctions of the body. I have been informed that acupuncture is a safe method of treatment, but it may have side effects, including bruising, numbness or tingling near the needling sites that may last a few days and dizziness or fainting. I understand that I should not move while the needles are being inserted, during treatment, or when the needles are being removed. Unusual risks of acupuncture include lung puncture (pneumothorax) if acupuncture is performed in the region of the lung. Infection is another possible risk, although the acupuncturist below uses sterile disposable needles and maintains a clean safe environment. I understand that while this document describes the major risks of treatment, other side effects and risks may occur. I will notify the doctor who is caring for me if I am or become pregnant. Although acupuncture is safe to use during pregnancy, there are some acupuncture points to be avoided in pregnancy. I will also notify the doctor if I have a bleeding disorder, if I am taking anti- coagulants or other medication. DO NOT SIGN UNTIL YOU HAVE READ AND UNDERSTAND THE ABOVE. I have read, or have had read to me, the above explanation. By signing below I state that I have weighed the risks involved in undergoing treatment and have decided that it is in my best interest to undergo the treatment recommended realizing that no guarantees can be made regarding the outcome of treatment. Having been informed of the risks, I hereby give my consent to treatment. I intend this consent form to cover the entire course of treatment for my present condition and for any future conditions for which I seek treatment. Patient’s Name Date Patient’s Signature (or Parent/Guardian) Print name of Parent or Guardian (if a minor) NOTICE OF PRIVACY PRACTICES—ACKNOWLEDGEMENT & CONSENT TO USE AND DISCLOSE PROTECTED HEALTH INFORMATION Use and Disclosure of your Protected Health Information Your Protected Health Information will be used by Gerhardson Chiropractic or may be disclosed to others for the purposes of treatment, obtaining payment, or supporting the day-to-day health care operations of this office.

Acupuncture treatment. Acupuncture attempts to normalize physiological functionsI understand acupuncture treatment is being provided by an Indiana State Licensed Acupuncturist. I understand methods of treatment may include, to modify the perception of painby are not limited to: acupuncture, moxibustion, cupping, and nutritional counseling. I appreciate it is not possible to treat certain diseases and dysfunctions of the bodyconsider every possible complication to care. I have been informed that acupuncture is a generally safe method of treatment, but, as with all types of healthcare interventions, there are some risks to care, including, but it may have side effects, including not limited to: bruising, ; numbness or tingling near the needling sites that may last a few days days; and dizziness or fainting. I understand that I should not move while the needles Xxxxx and/or scarring are being inserted, during treatmenta potential risk of moxibustion and cupping, or when treatment involves the needles are being removeduse of heat. Bruising is a common side effect with cupping. Unusual risks of acupuncture include nerve damage and organ puncture, including lung puncture (pneumothorax) if acupuncture is performed in the region of the lung). Infection is another possible risk, although the acupuncturist below Agency uses sterile disposable needles and maintains maintain a clean and safe environment. I understand that while this document describes the major risks of treatment, other side effects and risks may occur. I will notify the doctor acupuncturist who is caring for me if I am am, or become pregnant. Although acupuncture is safe to use during pregnancybecome, there are some acupuncture points to be avoided in pregnancy. I will also notify the doctor if I have a bleeding disorder, pregnant or if I am taking anti- coagulants or other medicationnursing. DO NOT SIGN UNTIL YOU HAVE READ AND UNDERSTAND THE ABOVE. While I have readdo not expect the acupuncturist to be able to anticipate and explain all the possible risks and complications of treatment, or have had read I wish to merely on the acupuncturist to exercise judgment during the course of treatment which the acupuncturist thinks at the time, based upon the above explanation. By signing below I state that I have weighed the risks involved in undergoing treatment facts then known, and have decided that it is in my best interest interest. I understand that, as with all healthcare approaches, results are not guaranteed, and there is no promise to undergo cure. I understand that I must inform, and continue to fully inform, this Agency of any medical history, family history, medications, and/or nutritional supplements being taken currently (prescription and over-the-counter). I understand the treatment recommended realizing that no guarantees can Clinical Director, acupuncturist, and administrative staff may review my client records and possible lab reports, but all my records will be made regarding the outcome of treatment. Having been informed kept confidential and will not be released outside of the risksAgency without my written consent. I understand that there are treatment options available for my condition other than acupuncture procedures. These options may include, but are not limited to: self-administered care, over-the-counter pain relievers, physical measures and rest, medical care with prescription drugs, physical therapy, bracing, injections and surgery. Lastly, I hereby give understand that I have the right to a second opinion and to secure other options about my consent to treatment. circumstances and healthcare as I intend this consent form to cover the entire course of treatment for my present condition and for any future conditions for which I seek treatment. Patient’s Name Date Patient’s Signature (or Parent/Guardian) Print name of Parent or Guardian (if a minor) NOTICE OF PRIVACY PRACTICES—ACKNOWLEDGEMENT & CONSENT TO USE AND DISCLOSE PROTECTED HEALTH INFORMATION Use and Disclosure of your Protected Health Information Your Protected Health Information will be used by Gerhardson Chiropractic or may be disclosed to others for the purposes of treatment, obtaining payment, or supporting the day-to-day health care operations of this officesee fit.