Updated 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 though is under better control. 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.

If your body temperature 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. We will not charge a cancellation fee in this situation.

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 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.

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.

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.

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. 

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.