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The State of Minnesota, through their passed law of Complementary and
Alternative Health Care, outlined a provision requiring all unlicensed
practitioners of complementary and alternative health care services to
provide all clients with a Client Bill of Rights prior to rendering
services. While this is not required in the state of California, I
believe this to be a positive step for all concerned. This document is
based on the Minnesota outline for requirements of a Client Bill of
Rights.
1.
Name:
________________________________________Phone #: ____________________
Address:
__________________________________________________________________
City, State Zip:
_____________________________________________________________
2. For a complete resume of degrees, training, experience and
qualifications, please see the attached. (Create and Attach your resume
of training to this document)
THE STATE OF _________________ HAS NOT ADOPTED ANY EDUCATIONAL AND
TRAINING STANDARDS FOR UNLICENSED COMPLEMENTARY AND ALTERNATIVE HEALTH
CARE PRACTITIONERS. THIS STATEMENT OF CREDENTIALS IS FOR INFORMATION
PURPOSES ONLY.
Under (your state) law, an unlicensed complementary and alternative
health care practitioner may not provide a medical diagnosis or recommend
discontinuance of medically prescribed treatments. If a client desires a
diagnosis from a licensed physician, chiropractor, or acupuncture
practitioner, or services from a physician, chiropractor, nurse,
osteopath, physical therapist, dietitian, nutritionist, acupuncture
practitioner, athletic trainer, or any other type of health care
provider, the client may seek such services at any time.
3. I, (practitioner name), am a sole provider of services, and therefore
have no supervisor. Any complaints about services received should be
filed directly with me using the contact information above. (If you have
a supervisor, change this as necessary, with address and contact
information)
4. There is currently no (state name) office of unlicensed complementary
and alternative health care practice to file complaints with. Other
traditional authorities will most likely receive complaints.
5. Fees for services rendered:
Initial appointment: $____. Appointment generally lasts ___ minutes
Successive appointments: $____hour
The client must cancel appointments with a minimum of 24 hour notice, or
still be responsible for the appointment fee in full.
Currently, I know of no specific insurance companies that accept claims
for the services offered in this office. On occasion, certain employer
insurance plans have accepted receipts for services rendered and
reimbursed the client. If you believe that you may be eligible for
reimbursement, I will gladly produce a receipt for services rendered and
the amount paid for them.
I do not accept Medicare, medical assistance or general assistance
medical care.
On occasion, I will negotiate to accept partial payment, or at my
discretion, waive payment, based on individual client circumstances.
Generally speaking, the first tier of reduced fee structure is $___ for initial appointment, $___
hour thereafter.
The above fees are subject to change at any time with 30-day notice.
I, (practitioner name), retain the right to discontinue service to anyone
at any time.
6. What follows is a brief summary of the theoretical approach of
Specialized Kinesiology:
Specialized Kinesiology uses muscle monitoring, also known as muscle
testing- a hands -on biofeedback tool to communicate with the body.
Muscle monitoring involves applying light pressure - generally about 2
pounds - usually on an arm or leg, which has been placed in a specific
position to isolate the action of a particular muscle. The response of
the muscle then offers specific information based on the context in which
it is being monitored. The information derived from muscle
monitoring/testing assists the practitioner to assess the area(s) of
imbalance and identify potential means of energy balancing from a variety
of complementary and alternative healing art forms in order to help the
client access their innate healing resources.
7. The client has the right to current and complete information regarding
any assessment and recommended service(s) that is to be provided in this
office, including the expected duration of the service(s) to be provided.
8. The client may expect courteous treatment, free from verbal, physical
or sexual abuse by me, (practitioner name).
9. Client records and transactions that result from services provided by
me, (practitioner name), are confidential, unless release of these
records is authorized in writing by the client, or otherwise provided by
law.
10. The client is entitled to have access to records and written
information from services rendered by me, (practitioner name).
11. The client should be aware that a plethora of health care services
are available from other practitioners in the immediate area. These
include, but are not limited to: traditional medical treatment,
chiropractic, acupuncture and massage. Information about other
complementary and alternative health care practices and practitioners is
generally available through freely distributed papers and magazines
through local health food stores and dispensers.
12. The client maintains the right to choose freely among available
practitioners and change practitioners after services have begun, within
the limitations of any health programs that the client may be involved
with.
13. The client has the right to a coordinated transfer of practitioners
if a change of provider of health insurance services or programs is
relevant and necessary.
14. The client has the right to refuse services or treatment, unless
otherwise provided by law.
15. The above rights of the client may be asserted by the client without
retaliation.
I acknowledge that I have received, read and understand the above
Client Bill of Rights.
__________________________________________
Signature of client:
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