La. Admin. Code tit. 46 § XXVII-915

Current through Register Vol. 50, No. 11, November 20, 2024

Section XXVII-915 - Form of Disclosure

A. Required Contents. The disclosure required by §911 shall be made in writing, shall be furnished to the patient, or the patient's authorized representative, prior to or at the time of making referral, and shall include:

1. the chiropractic physician's name, address and telephone number;

2. the name and address of the health care provider to whom the patient is being referred by the chiropractic physician;

3. the nature of the items or services which the patient is to receive from the health care provider to which the patient is being referred; and

4. the existence and nature of the chiropractic physician's financial interest in the health care provider to which the patient is being referred.

B. Permissible Contents. The form of disclosure required by §911 may include a signed acknowledgment by the patient or the patient's authorized representative that the required disclosure has been given.

C. Approved Form. Notice to a patient given substantially in the form of the Disclosure of Financial Interest Form, which may be obtained from the Board of Examiners, shall be presumptively deemed to satisfy the disclosure requirements of this Subchapter.

La. Admin. Code tit. 46, § XXVII-915

Promulgated by the Department of Health and Hospitals, Board of Chiropractic Examiners, LR 22:195 (March 1996).

AUTHORITY NOTE: Promulgated in accordance with R.S. 37:1744 and R.S. 37:1745.