Covid-19 Policy

INFORMED CONSENT FOR IN-PERSON SERVICES DURING COVID-19 PUBLIC HEALTH CRISIS

This document contains important information regarding in-person services provided by “Acupuncture and Herbal Medicine Healthcare” in light of the COVID-19 public health crisis. Please read this carefully and contact our clinic if you have any questions. When you sign this document, it will be an official agreement between you and our clinic.

Decision to Meet Face-to-Face

We have agreed that in-person services will be provided by our clinic. However, if there is a resurgence of the pandemic or if other health concerns arise, our clinic reserves the right to cancel your appointment and may discuss the feasibility to provide services via telehealth. Please understand that, if this decision is made, it is for everyone’s well-being.

If you decide at any time that you would prefer staying with, or returning to, telehealth services, the clinic will respect that decision, as long as it is feasible and clinically appropriate. Reimbursement for telehealth services, however, is also determined by the insurance companies and applicable laws, so whether the telehealth service is covered as part of your benefits, needs to be verified with a method of payment to be agreed upon before a telehealth session can be granted.

Risks of Opting for In-Person Services

You understand that by coming to our clinic, you are assuming the risk of exposure to the coronavirus (or other public health risks). This risk may increase if you travel by a public transportation, cab, or ride sharing service.

Your Responsibility to Minimize Your Exposure

To obtain services in person, you agree to take certain precautions which will help keep you, the practitioner, and other patients safe from exposure, sickness and possible death. If you do not adhere to these safeguards, our clinic reserves the right to either start or return to a telehealth arrangement if the services cannot be rendered in our clinic. By signing this consent form, you are indicating that you understand and agree to these conditions:

1. Your in-person appointment will only be honored if you have been vaccinated at least with two shoots of Covid-19 vaccine, have not been tested positive and you are free from exhibiting any Covid-19 symptoms publicized by the CDC including (inclusive listed here)   fever, cough, shortness of breath, difficulty breathing. loss of smell ,  headaches and etc.

2. Your body temperature will be taken at the clinic entrance upon arrival. If your body temperature reads 98.6 Fahrenheit and above, or if you have other symptoms of the coronavirus, our clinic reserves the right to cancel your appointment and discuss using telehealth as an alternative. We will not charge a cancellation fee in that situation.

3. If you have been exposed to other people who are infected, traveled to any foreign countries or areas within the United States with a high infection rate, or assumed responsibilities or activities that put you in close contact with others or any infected residents of your home, you will need to immediately inform our clinic. Our clinic reserves the right to decline providing our service based on the best medical assessments. You may also consider a telehealth session if it is appropriate.

4. You will wait in your car or outside until the appointment time and after receiving a text message or phone call from our clinic to enter.

5. Any person accompanying you must wait outside of our clinic such as in a personal vehicle. Exceptions are only allowed for parents/guardian for children under 12 years old or any patients who need assistance.

6. Upon entering the clinic, you will need to wash your hands or use alcohol-based hand sanitizer provided by our clinic.

7. You will need to adhere to the safe distancing precautions set up by the clinic. You will sit in the designated chair and area when your intake is being taken and the treatment is conducted.

8. You, your parents/guardians, and your assistant, will need to wear a mask for the entire duration in our clinic, including in the treatment room and the bathroom.

9. You are not permitted to bring your child or children to our clinic. You will need to make proper child care arrangements to keep them home or outside of our clinic.

10. You will need to take all precautionary steps between appointments to minimize your exposure to COVID-19.

The above precautions may change if additional local, state or federal orders or guidelines are published. If that happens, any necessary changes will be discussed.

Our Clinic’s Commitment to Minimize Exposure

Our clinic has taken steps and adhered to the protocols listed below, to reduce the risk of spreading the coronavirus within the clinic in order to protect you and other patients. Please contact our clinic if you have questions about these efforts.

1. The practitioner will ensure and check the following before providing any services on a daily basis:

. The practitioner has not been tested positive and is free from exhibiting any Covid-19 symptoms publicized by the CDC including (inclusive listed here)   fever, cough, shortness of breath, difficulty breathing. loss of smell ,  headaches and etc.

. The practitioner’s body temperature reads no higher than 98.6 Fahrenheit. 

. The practitioner has not been exposed to other people who are infected, traveled to any foreign countries or areas within the United States with a high infection rate, or assumed responsibilities or activities that are in close contact with others, or any infected family members.

2. The practitioner will wear the proper PPE (Personal Protective Equipment) for the entire duration of the treatment:

· N95/NK95 or medical procedure/surgical mask

· Protective shield if necessary

· Disposable latex gloves (one-time use) if necessary

· Proper protective clothing/isolation gown if necessary

3. Patients will be staggered upon entering our clinic. There will be no more than one patient seen at the same time. Only after the previous patient leaves the clinic, the next patient will then be notified and admitted to the clinic.

4. Disinfectant wipes or alcohol will be used to sanitize all areas and places that have been touched after each patient leaves our clinic and before the next patient walks into our clinic. These include the treatment bed, door knobs/handles, light switches, bathroom toilet surfaces, bathroom counter tops, and chairs.

5. The pulse and tongue diagnosis will only be conducted on an as needed basis. There will be an extra thick sneeze guard distancing barrier with a pass through between you and the practitioner when conducting a pulse reading or examine the tongue.

6. The practitioner will wash their hands:

· Before and after touching each patient

· When entering and leaving the treatment room

· Before and after needling and when other techniques are applied

· If gloves are used for needling, they are disposed after each patient, followed by hand washing with soap or alcohol.

If You Are or I Am Sick

Please understand that we are committed to keeping all of our patients safe from the spread of this virus. If you show up for an appointment and we believe that you have a fever, show other symptoms, or believe you have been exposed, we will have to require you to leave the office immediately. We can follow up with services by telehealth as appropriate.

If the practitioner tests positive for the coronavirus after providing service to you, we will notify you so that you can take appropriate actions.

Your Confidentiality in the Case of Infection

If you have tested positive for the coronavirus, the clinic is required to notify local health authorities that you have come to our clinic to not be treated. Only the minimum information necessary for their data collection will be provided and no specific details about the reason(s) for your visit will be disclosed. By signing this form, you agree that our clinic may do so without an additional signed release.

Informed Consent

This agreement supplements the general informed consent/business agreement that we agreed to at the start of our work together.

Your will be required to sign this consent that you agree to these terms and conditions.