ASMB Newsletter Issue 30 DRAFT 4 - armedicalboard.org · from ill doing and from seduction of men...

Arkansas State Medica l Board 2100 River front Drive

L itt le Rock, AR 72202-1435

As a member of the state Medical Board I get to see and read a lot of complaints about physi-cians in some kind of trouble. Many com-plaints against physicians involve them not meeting the expectations of the patients. Let-ter after letter, complaint after complaint, the patient states "I thought it said in the Hippo-cratic oath to.." and then comes the complaint. I've heard this so much I decided to look again at the Hippocratic oath and to try to determine what's really expected of me as a physician by the patients. It starts out swearing by Apollo and all the gods and no matter what your religious persua-sion I think this means that the expectation is that we'll have some kind of moral compass, some kind of belief in a Transcendent being who animates us and to whom we must an-swer. It's about being possessed of a good and kind core, and a spiritual energy that the pa-tients under our care can sense and respond to. It's the sense that we're all the same before God, that we acknowledge that our intellect and virtues are a gift from him and that in a very specific and wonderful way we're ex-pected to treat these patients like we'd want to be treated - medically, morally and financially. The next part of the oath deals with holding our teachers in high regard, to teach their off-spring the profession if they wish to learn it, and to teach others who have agreed to the rules of the profession. This involves the ex-pectation of lifelong learning, of CME and taking to heart what older and more experi-enced physicians have learned and have tried to teach us. It's also the expectation that we will generously teach medical students and residents, even when it's easier to just go ahead and get it done and that we won't participate in teaching unscrupulous personnel who might take shortcuts in patient care or who might not

Issue Number Thir ty

The Hippocratic Oath

By Joseph M. Beck II, M.D .

Summer 2006

BOARD MEMBERS

• W. Ray Jouett, M.D. Chairman

Little Rock, AR

• Orman W. Simmons, M.D. Vice Chairman

Little Rock, AR

• David C. Jacks, M.D. Secretary

Pine Bluff, AR

• Mrs. Bobbye H. Dennis Treasurer

Little Rock, AR

• Joseph M. Beck, II, M.D. Little Rock, AR

• John E. Bell, M.D. Searcy, AR

• Mrs. Anne Britton Fayetteville, AR

• William F. Dudding, M.D. Fort Smith, AR

• Trent P. Pierce, M.D. West Memphis, AR

• Douglas F. Smart, M.D. Little Rock, AR

• C. E. Tommey, M.D. El Dorado, AR

• Alonzo D. Williams, Sr., M.D. Little Rock, AR

• James E. Zini, D.O. Mountain View, AR

LEGAL COUNSEL

William H. Trice, III 425 West Capitol Avenue

Suite 400 Little Rock, AR 72201

(501) 372-4144

N E W S L E T T E R

Peggy Pryor Cryer Executive Secretary

2100 Riverfront Drive Little Rock, AR 72202

have the patients best interests at heart. It's about treating other physicians with respect, courtesy and kindness, even when they're calling you for a 2 AM consult or with someone who can't pay or who does-n't have the right kind of insurance. The next part talks about prescribing regi-mens for the good of the patients, not harming them and not giving a deadly drug or causing a death. Now, I'm a medi-cal oncologist and this is cutting pretty close to home but I think the expectation is that we'll put the patient first not the insurance company or the cost of the regi-

The Hippocratic Oath Board ........ 1-2

Additional Sample Controlled Substance Agreement ............................ 2

Continuing Education Reminder ...... 2

Board Actions......................... 3

Boards Warned of Third Party License ............................... 3

Board Meeting Dates................. 3

Guidelines for Investigations of Complaints of Violations of the Chronic Intractable Pain Treatment Act .... 3

Technology Update ................... 4

Are You Retired?..................... 4

Non-compliance With CCVS Mandate4

Allied Health Care Update........... 5

Occupational Therapist Continuing Education.............................. 5

Faxing Documents to the CCVS ..... 6

Authorization and Release Issues ... 6

A&R Helpful Hints.................... 7

Change of Address Form............. 8

INSIDE THIS ISSUE


The Board has approved an additional Sample Con-trolled Substance Agreement for patients to sign in re-gard to being treated for chronic pain. This additional contract was recommended by the Pain Management Review Committee and further outlines the intent of the guidelines stated in Regulation 2.6. To obtain a copy of the sample contract go to our website, www.armedicalboard.org and download the online ver-sion of this newsletter issue. You can also call our of-fice to request a copy.

ADDITIONAL SAMPLE

CONTROLLED SUBSTANCE AGREEMENT

REMINDER CONTINUING EDUCATION

Regulation 17 details that 20 hours of CME are re-

quired annually to maintain physi-cian licenses. The regulation also requires that “Continuing medical education records must be kept by the licensee in an orderly manner. All records relative to continuing medical education must be main-tained by the licensee for at least (3)

years from the end of the reporting period. The records or copies of the forms must be provided or made avail-able to the Arkansas State Medical Board upon re-quest”. Each month physicians are randomly selected to be audited for compliance with CME requirements.

insurance company, the cost of the regimen, the convenience of the staff or hospital or even Medicare. Although we can think of cost on a global scale, we must try never to think of it on an individual basis and even if it crosses our mind in the examination room to measure that thought by the competing one that says that the pa-tient comes first. In these days of capital punishment and euthana-sia the oath talks about not causing a deliberate death. The public expects doctors to be altruistic above all. And although a DNR order is OK, deliberately and knowingly crossing that line with a little too much morphine isn't. Patients want us to be able to draw a firm moral line and to recognize that some things are beyond us. This may even apply to the state doing the dirty work. I'm not say-ing that if someone raped and killed someone dear to me that I wouldn't want to help execute them; I'm only human and I might but a physician should not according to the oath, be involved in these things professionally. The next part talks about preserving the purity of my life and my art. The expectation here is that being a doctor (and all the moral-ity that it entails) doesn't stop at the office or hospital door. People expect doctors to be kind, generous, non-judgmental and selfless. The dirty little secret is of course that we're all human and I can think ugly thoughts with the best of them. We're watched and the esteem and respect in which we are held depends in some way on how we conduct ourselves at all times. I think this has to do with an expectation as to our genuineness, our sincerity and our integrity. They expect us to be above some degree of greed, pettiness or rudeness. I will not cut for stone but will leave this operation for those who are specialists......We're expected to refer when we need to refer. We're expected to ask questions from out of state experts even though it takes forever to get them on the phone. We're expected to have some degree of humility and to freely admit that we don't know everything. The patients expect that you'll put their health over your ego, that even if someone comes along and proves you wrong or an imbecile you don't care, or at least you don't care much, because the patient got better. In every house I'll go for the good of the patients and keep myself from ill doing and from seduction of men or women, slave or free. For 2400 years physicians have had a proscription against using their very real power and influence in enticing a patient into an inappropriate personal or sexual relationship, and yet it happens every day. We deal with it every 2 months when the medical board meets. Hippocrates must have been aware how powerful this temp-tation is, and it must have been ongoing even then. We all want to be loved and admired and the shortcut is to let our professional credentials be the attractant instead of whom we really are deep inside. It's a way to avoid disclosure and the real work of relation-ship and it is tempting. Of course for some it's all about the power but people come into our presence and disrobe both physically and emotionally with the expectation that we will put their ultimate good over any desires, temptations or pathology we might have and that HIPPA or not, we will keep that trust. SO strong is this pro-scription, that it is in our common law and has been for hundreds of years, and is equal to the seal of the confessional, the most sacred of promises that a Catholic priest makes. And if a physician who has made these promises, who has taken this oath, fails to keep it,

then the reverse of what is promised (enjoyment of life, practicing the art, respect from all men and in all times) will happen. If breaking that promise and knowing that you did isn't enough, then society has fashioned a way, through the Medi-cal Boards, peer pressure and legal system, of taking away the enjoyment of life, the practice of the art and the respect of men. Like so many things in life, if you don't do some-thing for a good reason, do it for a pragmatic one and some-times if you're lucky the two will start to blur together. Those externalized expectations with consequences become internalized ones and that's part of what growth is.

SCHEDULED MEETINGS OF THE

ARKANSAS STATE MEDICAL BOARD…

DATES FOR THE 2006 MEETINGS OF THE ARKANSAS STATE MEDICAL BOARD

August 3-4, 2006 October 5-6, 2006

December 7-8, 2006

*The Board will hold “called” meetings when necessary.

Meetings will be held in the Conference Room at the

Board’s office at 2100 Riverfront Drive Little Rock, Arkansas

Collie, William Richard, IV, M.D. (C-2220) Little Rock, AR - Revoked, 6/12/2006 Covington, Brenda Kaye, M.D. (E-0002) Little Rock, AR - Returned to Active, 6/14/2006 Fedosky, Scott David, M.D. (E-0546) Fayetteville, AR - Revoked, 6/21/2006 Hill, Shirlene Brooks, D.O. (N-8382) Lake Village, AR - Returned to Active, 6/15/2006 Nichol, Brian Thomas, M.D. (E-0476) North Little Rock, AR - Emergency Order of Suspension, 6/8/2006

BOARD ACTIONS & LICENSE ADJUSTMENTS Board Actions May 1, 2006 through June 27, 2006

Actions are listed in chronological order for each licensee, the top action listed is the most current.


Pursuant to Acts 1405 of 2003 and 2164 of 2005 the Arkansas State Medical Board has adopted the Guide-lines for Investigations of Complaints of Violations of the Chronic Intractable Pain Treatment Act as drafted and recommended by the Pain Management Review Committee. To obtain a copy of these Guide-lines go to our website, www.armedicalboard.org and download the online version of this newsletter issue. You can also call our office to request a copy.

Guidelines for Investigations of Complaints of Violations of the Chronic Intractable Pain Treatment Act

State medical boards, particularly those with online applications, should be aware of third party license renewal services contacting physicians by e-mail regarding medi-cal license renewal. The Oklahoma State Board of Medical Licensure and Supervi-sion has reported one of its physicians was recently contacted by an online service offering to file his medical license renewal for him. The physician mistakenly be-lieved the e-mail was from the board, completed the application and was charged $495 by a company called www.Medlicense.com. The mistake was found only after the board contacted the physician because his renewal application was late. The site states it will complete all licensure forms for renewal in all 50 states, including Federation Creden-tials Verification Service (FCVS) forms. The site is located at http://www.medlicense.com and is in no way connected to the FSMB, any of its services or to any of the state licensing boards. Boards should make sure their licensed physicians are aware of such third party services and the fact that, if the physician uses such a service for renewal instead of the state board, he or she is responsible for any inac-curacy or missed deadlines due to using the service.

Boards Warned of Third Party License Renewal Website


Did you receive a request or application from an insur-ance company when you are semi or totally retired? With the passing of the Any Will-ing Provider law, several physicians have received ap-plications simply because they still maintain an Active

Arkansas license and the insurers want to get them credentialed in a timely manner in case any patient in Arkansas sees that physician. If you received that documentation, or request for infor-mation from the ASMB/Centralized Credentials Verification Service (CCVS) and you are retired and no longer see patients, please fax a letter to 501-296-1806 stating that you are retired and no longer practicing. The CCVS will remove your name from the CCVS list to update your creden-tials and notify the insurance network that the request for your credentialing information is be-ing canceled and the reason. Be sure that if your situation changes and you decide to do locum tenens or work again, you will be required to no-tify the CCVS so your credentialing information can be updated.

ARE YOU RETIRED AND HAVE RECEIVED

NEW INSURANCE NETWORK APPLICATIONS?

NON-COMPLIANCE WITH CCVS MANDATE PHYSICIANS, OFFICE MANAGERS AND CREDENTIALING STAFF!

There are several organizations that still remain non-compliant with the state mandate. If you know of an organization that is requiring you to provide copies of your DEA, Certification Letter, Insurance Certifi-cate, Other State Licenses or to provide you with a list of your staff appointments, employment or work history – please notify the CCVS either via e-mail at [email protected] or phone to 501/296-1951. Your name will not be involved in the compliance contact with the organization. If you have a question regarding what is covered and what is not covered by the CCVS, please contact the CCVS Customer Ser-vice Manager at the e-mail address and phone number listed above for assistance.

TECHNOLOGY UPDATE

The Medical Board’s Information Tech-nology department has been working with various customer committees and the Board’s Management Team toward plan-ning future program enhancements and

future endeavors of the Arkansas State Medical Board. The IT staff reminds all physicians and customers, or anyone emailing the CCVS or Board, to please check your virus updates to prevent an inadvertent infection of everyone on your address list. You are advised not to open any attach-ments that are not Adobe PDF or open any of those from an unknown or un-recognizable source. There are a lot of clever ploys sent over the Internet to fool even the most experienced user into opening an attachment and releasing a virus or worm. Due to the continual influx of Internet viruses, the Medi-cal Board can no longer accept e-mail file attachments unless they are sent in Adobe PDF format. ALL FILE ATTACHMENTS MUST BE SENT DI-RECTLY TO THE SUPPORT DEPARTMENT at [email protected] for scanning.

Please indicate who the recipient is on the subject line.

PLEASE BE AWARE OF THIS POLICY

WHEN SENDING ROSTERS.

The following has been posted to the

Arkansas State Medical Board’s Website for reference.

At the Arkansas State Medical Board meeting October 6, 2005, the Board unanimously voted during a public hearing to amend Regulation 6 for Occupational Therapist and Regulation 10 for

Respiratory Therapist providing renewal fee increases to each discipline by $5.00. The new fees will become effective with the January 2006 renewals as follows:

Occupational Therapy - $55.00 renewal fee

$25.00 late fee (per year inactive) Respiratory Therapy- $30.00 renewal fee

$10.00 late fee (per year inactive)

Dates for the 2006 Occupational Therapy Examining Committee are:

August 7, 2006 October 9, 2006

Dates for the 2006 Respiratory Therapy

Examining Committee are: July 28, 2006

October 13, 2006 Upcoming meeting dates for the Physician Assistant

Advisory Committee are: Wednesday, August 2, 2006 at 2:00 Wednesday, October 4, 2006 at 2:00 Wednesday, December 6, 2006 at 2:00

Meeting dates and times are subject to change.

ALLIED HEALTHCARE UPDATE

2006 OT/RT CEU Audits Are you ready?

THANKS! The staff of the ASMB and Centralized Credentials Verification Service (CCVS) would like to take a moment to thank the physicians and credentialing staffs for their patience, cooperation and assistance. You are very much appreciated.


Do you need an easy source for obtaining an hour of continuing education? The Arkansas Rules and Regulation Questionnaire is available by contacting Mikki Hughes at the Arkansas State Medical Board via email at [email protected] The questions (10) are a sample of the law and regulation governing the practice act for OT’s and OT-A’s and they enable the taker to test their working knowledge of the practice act. If the licensee scores 8/10 they are awarded (1) hour, or (1) CEU of continuing education. The questionnaire can be used for continuing education (1) time per renewal cycle. The an-swers are found within Arkansas annotated code 17-88-101 through 17-88-312 and Regula-tion No. 6. This document can be obtained at www.armedicalboard.org

The Occupational Therapy Examin-ing Committee reserves the right to modify the questions at their discre-tion.

Occupational Therapist Continuing Education

STATE OF ARKANSAS

CENTRALIZED CREDENTIALS VERIFICATION SERVICE

NEWS BRIEFS


Between April 1 and June 15, 2006, the CCVS received 152 Authorization & Release forms that could not be entered, resulting in delays in customers’ credentialing process. 48 - signature date was illegible, incomplete, missing, or incorrect; 43 - organization name did not match the customer name on file; 21 - there was no organization name at all;

8 - the authorization and release wording had been changed and now does not meet CCVS requirements; 8 - the physician was not in our system (not licensed in Arkansas); 8 - the physician’s license had not yet been issued; 5 - the effective period was less than 2 years; 3 - the document was altered without the physician initialing the changes; 3 - the license number did not belong to the physician who signed; 2 - the physician could not be identified (printed name & license number were missing), illegible signature was the only identifier; 2 - the A&R was expired; 1 - the A&R was not signed by the physician. To download the latest version of our Authorization & Release form, as well as Helpful Hints for completing the form, visit www.armedicalboard.org, click on Information > Downloads > Authorization and Release – Single Facility.

AUTHORIZATION AND RELEASE ISSUES

FAXING DOCUMENTS TO THE CCVS

If an organization is sending faxed documents to the Centralized Credentials Verifica-tion Service (CCVS), please be aware that your confirmation is only confirming the fax was sent. It does not confirm that the fax was safely received by the CCVS. Faxes do go awry and are never received by the CCVS or are not legible once received. If your Authorization and Releases are not posted after 24 hours, please send a query e-mail to [email protected] and inquire about the status. You may want to wait for a response before re-sending because in some cases, you will be asked to try send-ing it to another fax number if there is a large document or volume coming in. Please try to send your faxes at least 24 hours before needing to post to allow for any prob-lems with receiving the A&R to be resolved.


AUTHORIZATION AND RELEASE FORM Helpful Hints

Before you fax your Authorization & Release form to CCVS, please make sure the following guidelines are met

Wording If you wish to incorporate the Arkansas State Medical Board Authorization and Release (A&R) into your organization’s medical staff application or consent form, you are welcome to do so, but be advised that the wording MUST match the wording on our form, including the effective period (2 years). In addition, the text MUST be easily identifiable by our staff for example (indented, bolded, underlined, or in a text box, and must be located above the signature line).

Organization Name Your organization name MUST match the name listed in the sign-up process. Since the CCVS has organizations with the same abbreviations, the CCVS will not enter A&R’s with any type of abbreviation in the blank organization line. If you list multiple names on the form, all organizations listed on the form will be entered. If only one organization on a multiple listing should be used, you must circle the appropriate organi-zation. Organizations may print their name on the A&R’s before giving to the physician to sign in order to save time and ensure the correct name is listed in the blank.

Physician Name The physician’s name MUST be complete—including middle initial, Jr., Sr., etc. when applicable—and legible, either typed or printed. The CCVS may have more than one physician with the same first and last name. Arkansas License Number Please ensure that the physician is an M.D. or D.O. and is currently licensed in Arkansas. The CCVS cannot post A&Rs on physicians whose licenses are inactive, still pending or have not yet applied for an Ar-kansas license.

Signature of Physician DO NOT use a signature stamp, and please encourage the physician to sign in BLACK ink; it comes through more clearly when faxing.

Date Signed The date the physician signed the form MUST be included on this form, and MUST be complete with month, day, and year signed. Encourage the physician to write the date CLEARLY; we cannot accept A&Rs where the date is at all questionable.

ANY ALTERATIONS OR CHANGES MADE TO THE AUTHORIZA-TION & RELEASE FORM AFTER THE ORIGINAL SIGNATURE

DATE MUST BE INITIALED AND DATED BY THE PHYSICIAN. NO ONE BUT THE PHYSICIAN MAY ALTER THIS FORM AFTER THE

PHYSICIAN SIGNS IT. WE CANNOT ACCEPT A&RS WITH SCRATCH-OUTS OR OVERWRITES UNLESS THEY ARE INI-

TIALED AND DATED BY THE PHYSICIAN.

Alterations to A&R

Arkansas State Medical Board 2100 Riverfront Drive Little Rock, AR 72202-1435

C H A N G E O F A D D R E S S F O R M

P L E A S E F A X ( 5 0 1 ) 6 0 3 - 3 5 5 5 E M A I L ( L I C E N S I N G @ A R M E D I C A L B O A R D . O R G )

O R M A I L T O : A R K A N S A S S T A T E M E D I C A L B O A R D 2 1 0 0 R I V E R F R O N T D R I V E L I T T L E R O C K , A R 7 2 2 0 2 - 1 4 3 5 N A M E : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ L I C E N S E N U M B E R : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ B U S I N E S S A D D R E S S : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ H O M E A D D R E S S : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ C I T Y : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ S T A T E : _ _ _ _ _ _ _ _ _ _ Z I P : _ _ _ _ _ _ _ _ _ _ B U S I N E S S P H O N E : ( _ _ _ ) _ _ _ _ _ _ _ F A X : ( _ _ _ ) _ _ _ _ _ _ _ H O M E : ( _ _ _ ) _ _ _ _ _ _ _ _ C U R R E N T E - M A I L A D D R E S S : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ E F F E C T I V E D A T E O F A D D R E S S C H A N G E : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ S I G N A T U R E : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Main Phone: (501) 296-1802 Regulatory Fax: (501) 296-1805 CCVS Fax: (501) 296-1806 Renewals, QI/CS, Accounting and Personnel Fax: (501) 603-3555 , Licensing Fax: (501) 296-1972

Mission of the Arkansas State Medical Board

Protecting the health, safety, and

welfare of the people of the State of Arkansas with the goal that all

citizens be provided with the highest quality health care.

We’re on the WEB!!! www.armedicalboard.org

WEB INFORMATION CENTER

C O P I E S O F A L L B O A R D REGULATIONS ARE INCLUDED IN THE MEDICAL PRACTICES ACT BOOKLET. It is the physician’s responsibility to read and comply with these rules.

DIRECTORIES AVAILABLE ON CD ROM Printed directories are no longer

available. M.D. & D.O.s may obtain a free 2005—2006 Directory on CD-

ROM by calling the Board and requesting one.

All others may order via the

website, at $25/CD, payment is via credit card only.

MEDICAL PRACTICES ACT BOOKLETS

$15 PER COPY or free from the web site

at

www.armedicalboard.org

www.armedicalboard.org

SAMPLE CONTROLLED SUBSTANCE AGREEMENT We are committed to doing all we can to treat your chronic pain condition. In some cases, opioids and other controlled substances are used as a therapeutic option in the management of chronic pain and related conditions all of which are strictly regulated by both state and federal agencies. This agreement is a tool to protect both you and the physician by establishing guidelines, within the laws, for proper controlled substance use.

1. All controlled substances have a potential for dependency and abuse. 2. All controlled substances must come from the physician whose signature appears below or, during

his/her absence, by the covering physician, unless specific authorization is obtained for an exception.

3. All controlled substances must be obtained from the same pharmacy, where possible. Should the need arise to change pharmacies our office must be informed. The pharmacy that you have selected is:

_______________________________________________ phone:__________________

4. The prescribing physician has permission to discuss all diagnostic and treatment details with the

dispensing pharmacists or other professionals who provide your health care for the purpose of maintaining accountability.

5. You may not share, sell, or otherwise permit others including spouse or family members to have

access to these medications.

6. Unannounced urine or serum toxicology screens may be requested, and your cooperation is required. Presence of unauthorized substances may result in your discharge from the facility.

7. I will not consume excessive amounts of alcohol in conjunction with narcotics, nor will I use,

purchase, or otherwise obtain any illegal drugs.

8. Medications may not be replaced if they are lost, stolen, get wet, are destroyed, left on an airplane, etc.

9. If the responsible legal authorities have questions concerning your treatment, as might occur, for

example, if you were obtaining medication at several pharmacies, all confidentiality is waived and these authorities may be given full access to our records of controlled substance administration.

10. Early refills will not be given. Renewals are based upon keeping scheduled appointments. Please do

not phone for prescriptions after hours or on weekends.

11. In the event you are arrested or incarcerated related to legal or illegal drugs, refills on controlled substances will not be given.

12. It is understood that failure to adhere to these policies may result in cessation of therapy with

controlled substance prescribing by this physician.

13. You affirm that you have full right and power to sign and be bound by this agreement, and that you have read, understand, and accept all of its terms.

_______________________________________ Patient’s full name _______________________________________ _______________________ Patients’ signature Date _______________________________________ _______________________ Physician’s signature Date Adopted 2006

ASMB Newsletter Issue 30 DRAFT 4 - armedicalboard.org · from ill doing and from seduction of men...

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Transcript of ASMB Newsletter Issue 30 DRAFT 4 - armedicalboard.org · from ill doing and from seduction of men...