Common use of Tuberculosis Clause in Contracts

Tuberculosis. Reason for today’s visit (Describe) How long have you had this condition? Is it getting worse? Yes No What seemed to be the initial cause Describe your pain (circle those that apply): sharp dull achy shooting tingling burning stabbing stinging pulling pinching Have you seen a chiropractor before? Yes (If yes, how long ago?) For what reason: No Are you under the care of a physician? Yes (if yes, for what?) No Have you been hospitalized in the last 5 years? Yes No if yes, please describe Are you currently taking any medication? Yes No If yes, please list Please list any drug allergies: _ Please list any other health conditions you have been treated for, or surgery you have had: Family health info: Some health conditions are the result of hereditary spinal weaknesses. Info about your immediate family, brothers, sisters, parents, and grandparents, will give us a better understanding of your total health picture. Summary: (Doctor’s use) PATIENT NAME: Date of Birth: To the patient: Please read this entire document prior to signing. It is important that you understand the information contained in this document. Please ask questions before you sign if there is anything that is unclear. The primary treatment i use as a Doctor of Chiropractic is spinal manipulative therapy. I may use my hands or a mechanical instrument called an Activator in order to move your joints to improve their function, alignment and reduce nearby nerve irritation. You may feel a “click” or “pop,” and you may feel movement of the joints during the adjustment. Various ancillary procedures, such as massage, trigger point therapy, hot or cold packs, electric muscle stimulation, therapeutic ultrasound, or rehab exercises may also be used to aid in treatment and to prepare your body for the adjustments. By any standard, chiropractic adjustment is a conservative and very safe procedure. Chiropractic, as well as all other health professions, is associated with potential risks in the delivery of treatment. Therefore it is necessary to inform the patient of such risks prior to initiating care. While Chiropractic treatment is remarkably safe, you need to be informed about the potential risks related to your care to allow you to be fully informed before consenting to treatment. Chiropractic is a system of health care delivery and therefore, as with any health care delivery system, I cannot promise a cure for any symptom, condition, or disease as a result of treatment in this office. Although generally described as rare, chiropractic adjustments and physical therapy procedures may be accompanied by post treatment soreness, disc injury aggravation, muscle strains, minor ▇▇▇▇▇ to the skin while receiving moist heat, rare rib injury or fracture or in very rare incidents (with high risk patients) stroke. Precautions such as pre-treatment history, examination and diagnostic x-rays as needed prior to care minimize such risks, as well as performing all treatment carefully. Some patients will feel some stiffness and soreness following the first few days of treatment. I will make every reasonable effort during the examination to screen for contraindications to care; however, if you have a condition that would otherwise not come to our attention, it is your responsibility to inform me. Remaining untreated or delay of treatment may increase complications that include the formation of adhesions, scar tissue and other degenerative changes. These changes decrease joint motion and may lead to chronic pain. It is quite probable that delay of treatment will complicate the condition and make future rehabilitation more difficult. I do not expect the doctor to anticipate, nor explain all of the risks, and/or complications that are possible, but I will rely on the Doctor’s training and education which she feels necessary, based on the facts and diagnosis in my case, knowing that she will act in my best interest.

Tuberculosis. Reason for today’s visit (Describe) How long have you had this condition? Is it getting worse? Yes No What seemed to be the initial cause Describe your pain (circle those that apply): sharp dull achy shooting tingling burning stabbing stinging pulling pinching Have you seen a chiropractor before? Yes (If yes, how long ago?) For what reason: No Are you under the care of a physician? Yes (if yes, for what?) No Have you been hospitalized in the last 5 years? Yes No if yes, please describe Are you currently taking any medication? Yes No If yes, please list Please list any drug allergies: _ Please list any other health conditions you have been treated for, or surgery you have had: Family health info: Some health conditions are the result of hereditary spinal weaknesses. Info about your immediate family, brothers, sisters, parents, and grandparents, will give us a better understanding of your total health picture. Summary: (Doctor’s use) PATIENT NAME: Date of Birth: To the patient: Please read this entire document prior to signing. It is important that you understand the information contained in this document. Please ask questions before you sign if there is anything that is unclear. The primary treatment i use as a Doctor of Chiropractic is spinal manipulative therapy. I may use my hands or a mechanical instrument called an Activator in order to move your joints to improve their function, alignment and reduce nearby nerve irritation. You may feel a “click” or “pop,” and you may feel movement of the joints during the adjustment. Various ancillary procedures, such as massage, trigger point therapy, hot or cold packs, electric muscle stimulation, therapeutic ultrasound, or rehab exercises may also be used to aid in treatment and to prepare your body for the adjustments. By any standard, chiropractic adjustment is a conservative and very safe procedure. Chiropractic, as well as all other health professions, is associated with potential risks in the delivery of treatment. Therefore it is necessary to inform the patient of such risks prior to initiating care. While Chiropractic treatment is remarkably safe, you need to be informed about the potential risks related to your care to allow you to be fully informed before consenting to treatment. Chiropractic is a system of health care delivery and therefore, as with any health care delivery system, I cannot promise a cure for any symptom, condition, or disease as a result of treatment in this office. Although generally described as rare, chiropractic adjustments and physical therapy procedures may be accompanied by post treatment soreness, disc injury aggravation, muscle strains, minor ▇▇▇▇▇ to the skin while receiving moist heat, rare rib injury or fracture or in very rare incidents (with high risk patients) stroke. Precautions such as pre-treatment history, examination and diagnostic x-rays as needed prior to care minimize such risks, as well as performing all treatment carefully. Some patients will feel some stiffness and soreness following the first few days of treatment. I will make every reasonable effort during the examination to screen for contraindications to care; however, if you have a condition that would otherwise not come to our attention, it is your responsibility to inform me. Remaining untreated or delay of treatment may increase complications that include the formation of adhesions, scar tissue and other degenerative changes. These changes decrease joint motion and may lead to chronic pain. It is quite probable that delay of treatment will complicate the condition and make future rehabilitation more difficult. I do not expect the doctor to anticipate, nor explain all of the risks, and/or complications that are possible, but I will rely on the Doctor’s training and education which she feels necessary, based on the facts and diagnosis in my case, knowing that she will act in my best interest.