Disclosures
None of the articles posted on this website are intended to create a doctor-patient relationship with you (or your company).
Although we may be “friends” or we may “follow” or “like” each other on social media platforms, that still does not make me your doctor and you are not my patient.
The articles you read here do NOT constitute medical advice and are not a substitute for seeking medical counsel from a medical professional.
The same goes for articles and information sent via newsletters or in e-mails or as social media status updates or links.
By submitting topics for consideration in our bi-weekly newsletters and social media outlets, you agree that
Midwest Sport and Spine Inc. is a participant in the Ebay Partnership Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to ebay.com.
Midwest Sport and Spine Inc. is a participant in the CJ Affiliates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to cjaffiliates.com.
Midwest Sport and Spine Inc. collect, use, store, and disclose data collected from readers visitors, including, where applicable, that third parties Amazon, Ebay, and other advertisers may serve content and advertisements, collect information directly from Midwest Sport and Spine Inc., and place or recognize cookies on our readers browsers.
Informed Consent to Care:
By reading this disclosure prior to examination and therapies, you hereby request and consent to the performance of therapeutic procedures, including various modes of physical therapy and diagnostic ultrasound or xray, on the patient performed at date of service; by the doctors and qualified staff members at Midwest Sport and Spine Inc. who are employed now or in the future. Although manipulation/adjustment is considered to be one of the safest, most effective forms of therapy for musculoskeletal problems, you are aware that there are possible risks and complications associated with these procedures such as Soreness: You are aware that like exercise it is common to experience muscle soreness in the first few treatments. Dizziness: Temporary symptoms like dizziness and nausea can occur but are relatively rare. Fractures/Joint Injury: you further understand that in isolated cases underlying physical defects, deformities or pathologies like weak bones from osteoporosis may render the patient susceptible to injury. When osteoporosis, degenerative disk, or other abnormality is detected, this office will proceed with extra caution. Stroke: Although strokes happen with some frequency in our world, strokes from manipulation are rare. You are aware that nerve or brain damage including stroke is reported to occur once in one million to once in ten million treatments. One in a million is about the same chance as getting hit by lightening. One in ten million is about the same chance as a normal dose of aspirin or Tylenol causing death. Physical Therapy Burns: Some of the therapies used in this office generate heat and may rarely cause a burn. Despite precautions, if a burn is obtained, there will be a temporary increase of pain and possible blistering. This should be reported to the doctor. Finally, you are aware that the appropriate tests have been performed on me to minimize the risk of any complication from treatment and you freely assume these risks.
Treatment Results:
You also understand that there are beneficial effects associated with these treatment procedures including decreased pain, improved mobility and function, and reduced muscle spasm, However, you appreciate there is no certainty that I will achieve these benefits. You realize that the practice of medicine, is not an exact science and you acknowledge that no guarantee has been made to me regarding the outcome of these procedures. You agree to the performance of these procedures by my doctor and other person of the doctor’s choosing.
Alternative Treatments Available:
Reasonable alternatives to these procedures have been explained to me including rest, home applications of therapy, prescription or over the counter medications, exercises and possible surgery. Medications: Medication can be used to reduce pain or inflammation. You are aware that long term use or overuse of medication is always a cause for concern. Drugs may mask pathology, produce inadequate or short term relief, undesirable side effects, physical or psychological dependence, and may have to be continued indefinitely. Some medications may involve serious risks. Rest/Exercise: It has been explained to me that simple rest is not likely to reverse pathology, although it may temporarily reduce inflammation and pain. The same is true of ice, heat, or other home therapy. Prolonged bed rest contributes to weakened bones and joint stiffness. Exercises are of limited value but are not corrective of injured nerve and joint tissues. Surgery: Surgery may be necessary for joint stability or serious disk rupture. Surgical risks may include unsuccessful outcome, complications, pain or reaction to anesthesia, and prolonged recovers. Non-treatment: You understand the potential risks of refusing or neglecting care may include increased pain, scar/adhesion formation, restricted motion, possible nerve damage, increased inflammation, and worsening pathology. The aforementioned may complicate treatment making future recovery and rehabilitation more difficult and lengthy.
No Show Fee:
To the extent permitted by law, the client/member/patient agrees to pay a no show fee in an amount not to exceed $35 within 3 hours of cancellation. The imposition and payment of a no show fee shall not constitute a waiver of the Bank's rights with respect to the default.
Cash payments:
Customers, clients, patients payment via cash shall pay on day of first visit.
Statement of Non-Pregnancy:
X-rays are a form of electromagnetic radiation that may have adverse effects on body tissue, especially rapidly dividing cells. It is during the first few months of pregnancy that the cells of an embryo are most susceptible to injury or the induction of serious congenital anomalies. Therefore, we have adopted the 10 day rule which recommends that woman undergoing radiographic procedures carry less risk to a developing embryo if performed within 10 days following the onset of a menstrual period, because ovulation and pregnancy are much less apt to occur during this time. However, if a radiographic examination is deemed medically necessary, it will be carried out with strict adherence to all available protective measures.
Notice of Privacy Policy:
We are required, by law, to maintain the privacy and confidentiality of your protected health information and to provide our patients with notice of our legal duties and privacy practices with respect to your protected health information. If applicable, we may disclose your health information, as deemed necessary by law, to comply with state Workers’ Compensation Laws, in cases of medical emergencies, to aid public health agencies such as the CDC and FDA, Governmental agencies as required by law, law enforcement officials and to comply with a court order, preapproved agencies for purposes of organ donation or research, or to proper authorities as recognized by the state in order to assure public safety. Your rights include the ability to request (only) restriction on certain uses and disclosures, to receive protected information by alternate means or at an alternate location, to have your physician amend your protected health information or file a statement of disagreement with your physician, and to receive an accounting of certain disclosures your physicians have made (if any). A more detailed explanation of these rights and responsibilities is readily available by us upon request, or at www.hfa.gov/medicaid/hippa. Questions, concerns, and/or complaints should be directs to DHHS, Office of Civil Rights 200 Independence Ave., S.W. Room 509F HHH Building in Washington, DC 20201 I have read or have had read to you the above explanation of treatment. You have made my decision voluntarily and freely. To attest to my consent to these procedures, You hereby agree to this authorization for treatment.
Although we may be “friends” or we may “follow” or “like” each other on social media platforms, that still does not make me your doctor and you are not my patient.
The articles you read here do NOT constitute medical advice and are not a substitute for seeking medical counsel from a medical professional.
The same goes for articles and information sent via newsletters or in e-mails or as social media status updates or links.
By submitting topics for consideration in our bi-weekly newsletters and social media outlets, you agree that
- you will NOT submit confidential information;
- you are not guaranteed a response; and
- information related to your submitted topic that is posted on this site, in The Midwest Sport and Spine newsletter, blog, or in any Midwest Sport and Spine social media status update does NOT constitute medical advice pertaining to you or your company.
Midwest Sport and Spine Inc. is a participant in the Ebay Partnership Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to ebay.com.
Midwest Sport and Spine Inc. is a participant in the CJ Affiliates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to cjaffiliates.com.
Midwest Sport and Spine Inc. collect, use, store, and disclose data collected from readers visitors, including, where applicable, that third parties Amazon, Ebay, and other advertisers may serve content and advertisements, collect information directly from Midwest Sport and Spine Inc., and place or recognize cookies on our readers browsers.
Informed Consent to Care:
By reading this disclosure prior to examination and therapies, you hereby request and consent to the performance of therapeutic procedures, including various modes of physical therapy and diagnostic ultrasound or xray, on the patient performed at date of service; by the doctors and qualified staff members at Midwest Sport and Spine Inc. who are employed now or in the future. Although manipulation/adjustment is considered to be one of the safest, most effective forms of therapy for musculoskeletal problems, you are aware that there are possible risks and complications associated with these procedures such as Soreness: You are aware that like exercise it is common to experience muscle soreness in the first few treatments. Dizziness: Temporary symptoms like dizziness and nausea can occur but are relatively rare. Fractures/Joint Injury: you further understand that in isolated cases underlying physical defects, deformities or pathologies like weak bones from osteoporosis may render the patient susceptible to injury. When osteoporosis, degenerative disk, or other abnormality is detected, this office will proceed with extra caution. Stroke: Although strokes happen with some frequency in our world, strokes from manipulation are rare. You are aware that nerve or brain damage including stroke is reported to occur once in one million to once in ten million treatments. One in a million is about the same chance as getting hit by lightening. One in ten million is about the same chance as a normal dose of aspirin or Tylenol causing death. Physical Therapy Burns: Some of the therapies used in this office generate heat and may rarely cause a burn. Despite precautions, if a burn is obtained, there will be a temporary increase of pain and possible blistering. This should be reported to the doctor. Finally, you are aware that the appropriate tests have been performed on me to minimize the risk of any complication from treatment and you freely assume these risks.
Treatment Results:
You also understand that there are beneficial effects associated with these treatment procedures including decreased pain, improved mobility and function, and reduced muscle spasm, However, you appreciate there is no certainty that I will achieve these benefits. You realize that the practice of medicine, is not an exact science and you acknowledge that no guarantee has been made to me regarding the outcome of these procedures. You agree to the performance of these procedures by my doctor and other person of the doctor’s choosing.
Alternative Treatments Available:
Reasonable alternatives to these procedures have been explained to me including rest, home applications of therapy, prescription or over the counter medications, exercises and possible surgery. Medications: Medication can be used to reduce pain or inflammation. You are aware that long term use or overuse of medication is always a cause for concern. Drugs may mask pathology, produce inadequate or short term relief, undesirable side effects, physical or psychological dependence, and may have to be continued indefinitely. Some medications may involve serious risks. Rest/Exercise: It has been explained to me that simple rest is not likely to reverse pathology, although it may temporarily reduce inflammation and pain. The same is true of ice, heat, or other home therapy. Prolonged bed rest contributes to weakened bones and joint stiffness. Exercises are of limited value but are not corrective of injured nerve and joint tissues. Surgery: Surgery may be necessary for joint stability or serious disk rupture. Surgical risks may include unsuccessful outcome, complications, pain or reaction to anesthesia, and prolonged recovers. Non-treatment: You understand the potential risks of refusing or neglecting care may include increased pain, scar/adhesion formation, restricted motion, possible nerve damage, increased inflammation, and worsening pathology. The aforementioned may complicate treatment making future recovery and rehabilitation more difficult and lengthy.
No Show Fee:
To the extent permitted by law, the client/member/patient agrees to pay a no show fee in an amount not to exceed $35 within 3 hours of cancellation. The imposition and payment of a no show fee shall not constitute a waiver of the Bank's rights with respect to the default.
Cash payments:
Customers, clients, patients payment via cash shall pay on day of first visit.
Statement of Non-Pregnancy:
X-rays are a form of electromagnetic radiation that may have adverse effects on body tissue, especially rapidly dividing cells. It is during the first few months of pregnancy that the cells of an embryo are most susceptible to injury or the induction of serious congenital anomalies. Therefore, we have adopted the 10 day rule which recommends that woman undergoing radiographic procedures carry less risk to a developing embryo if performed within 10 days following the onset of a menstrual period, because ovulation and pregnancy are much less apt to occur during this time. However, if a radiographic examination is deemed medically necessary, it will be carried out with strict adherence to all available protective measures.
Notice of Privacy Policy:
We are required, by law, to maintain the privacy and confidentiality of your protected health information and to provide our patients with notice of our legal duties and privacy practices with respect to your protected health information. If applicable, we may disclose your health information, as deemed necessary by law, to comply with state Workers’ Compensation Laws, in cases of medical emergencies, to aid public health agencies such as the CDC and FDA, Governmental agencies as required by law, law enforcement officials and to comply with a court order, preapproved agencies for purposes of organ donation or research, or to proper authorities as recognized by the state in order to assure public safety. Your rights include the ability to request (only) restriction on certain uses and disclosures, to receive protected information by alternate means or at an alternate location, to have your physician amend your protected health information or file a statement of disagreement with your physician, and to receive an accounting of certain disclosures your physicians have made (if any). A more detailed explanation of these rights and responsibilities is readily available by us upon request, or at www.hfa.gov/medicaid/hippa. Questions, concerns, and/or complaints should be directs to DHHS, Office of Civil Rights 200 Independence Ave., S.W. Room 509F HHH Building in Washington, DC 20201 I have read or have had read to you the above explanation of treatment. You have made my decision voluntarily and freely. To attest to my consent to these procedures, You hereby agree to this authorization for treatment.
