For your protection and the protection of your physician, Florida laws give patients the right to know about the treatment they receive. Sometimes, good practice requires that we tell you about risks associated with treatment or the use of medication, as well as the limitations of both. You are always welcome to ask for more details if you wish.
Precision Integrative Medicine, LLC practices integrative medicine, which includes Traditional Chinese Medicine (TCM), Acupuncture, Chinese Herbal Medicine and Oriental Medicine, known as Complementary and Alternative Medicine, also called “CAM”. Each patient is treated as an individual and there is no "one size fits all" course of diagnosis or treatment. Precision Integrative Medicine, LLC physicians will consider CAM modalities, possibly recommending one or more practices, diagnostics, or remedies.
The CAM practices utilized may include, but are not limited to, one or more of the following: acupuncture; dietary supplements; herbal remedies; exercise; lifestyle counseling; medicinal use of nutrition; massage; cupping; gua sha (scraping therapy); IASTM; moxibustion; stretching; physical manipulation; electrical muscle stimulation; mind-body techniques; needle retention; tuina (Chinese massage); electrical, laser, and/or magnetic stimulation; micropuncture (mild bleeding therapy); diagnostic palpation on various areas of my body; and other energy therapies.
I understand that the diagnosis given to me conforms to the principles of integrative medicine and TCM and in no way purports to replace allopathic (Western) medical evaluation, diagnosis, or treatment.
I have provided a full history and description of complaints and health status, which is complete and accurate. I understand that the need for communication with all of my health care providers regarding my health status is ongoing and necessary.
I understand that no guarantee has been made concerning the use and effects of TCM. I understand that in some cases, symptoms may relapse or intensify temporarily during the course of treatment before relief is sustained.
Different people react differently to the same treatment or medications. I understand it is only possible for my physician to properly manage my care completely if I communicate any difficulties I am having, or if medications are not effective or causing me discomfort.
I understand that I may stop treatment at any time.
I understand that while this document describes the major risks of treatment, other side effects and risks may occur.
Acupuncture: I understand that it is a technique using small, sterile, stainless needles inserted at specific points in the body, causing a positive response in order to correct various ailments. Only disposable needles are used. The location of the application of the needles and the depth of the needle insertion is determined by the nature of the problem. I understand that the application of these needles may be accompanied by a brief painful sensation, and that there is a slight possibility of minor swelling, bleeding, discoloration of the skin, hematoma, a bruise at the needling site, or fainting. Momentary euphoria or lightheadedness may occur after acupuncture treatment. The attending acupuncturist can easily handle any immediately reported problems that arise from the acupuncture treatment if they occur, and the possibility of minor problems need not be a cause of concern. Some very rare risks of acupuncture include pneumothorax and infection. Burns and/or scarring are a potential risk of indirect moxibustion. Rarely, massage and bodywork may cause a temporary increase of symptoms or new symptoms may present. If there is a medical emergency following treatment, please call 911.
Acupoint Injection Therapy (AIT): Acupoint Injection Therapy means the injection of herbs, homeopathics and other nutritional supplements in the form of sterile substances into acupuncture points to promote, retain, and restore health, for pain management and palliative care, for acupuncture anesthesia and to prevent disease. It is not a substitute for traditional needle acupuncture, but rather an adjunctive treatment that may be beneficial in attaining healing for the patient. Acupoint Injection Therapy may activate acupuncture points much in the same way as the insertion of needles with addtional healing provided by the remedies that are utilized during the injection. Acupoint Injection Therapy is associated with minimal discomfort, it is quick, easy and most patients will notice a positive response shortly after treatment. Rarely, AIT can cause bruising, redness, swelling, itching, burning, difficulty breathing, and swelling of the lips or tongue. Please notify your acupuncture physician of any allergies. It is not unusual to experience some minor discomfort/pressure at the injection site/s following treatment. This can vary from patient to patient and usually resolves within a 24hr time period.
Moxibustion: I understand is the application of indirect heat supplied by burning the herb Folium Artemisiae Vulgaris (commonly known as mugwort) over a single acupuncture point or a group of points. This generally produces a pleasurable sensation of relaxation. The area being treated may remain red and warm for several hours after treatment. In rare incidents, a minor burn may occur at the site of moxibustion. The attending physician can readily address this.
Cupping: I understand it uses round vacuum cups over a large muscular area, such as the back, to enhance blood circulation to the designated area. This method may produce a deep redness, discoloration and on rare occasions, a minor blister which may persist for up to a week. These marks may resolve on their own and are not indications of complications or injuries. Cupping is contraindicated for patients on blood thinners and those who have rashes and open wounds.
Qi Gong: Chinese for “energy work”, I understand it is a non-invasive healing modality that predates the use of acupuncture needles, and incorporates the same therapeutic basis as acupuncture.
Acupressure/Tui-Na Massage: I understand that I may also be given acupressure/tui-na massage as part of my treatment to modify or prevent pain perception and to normalize the body’s physiological functions. I am aware that certain adverse side effects may result from this treatment. These could include, but are not limited to: bruising, sore muscles or aches, and the possible aggravation of symptoms existing prior to treatment. I understand that I may request to stop the treatment if it is too uncomfortable.
Herbs and Nutritional Supplements: I understand that substances from the Oriental Materia Medica may be recommended to me to treat bodily dysfunction or diseases, to modify or prevent pain perception, and to normalize the body’s physiological functions. Herbs are used to facilitate the body’s own restorative process. The herbs are usually taken in tea form by boiling dried plants in their natural form and reducing to granules. Chinese herbal teas tend to taste bitter because they are made mostly from roots and barks. I understand that I am not required to take these substances but must follow the directions for administration and dosage if I intend to see results.
I understand that recommended herbs are traditionally considered safe in the practice of TCM, although some may be toxic in large doses. I understand that some herbs and dietary supplements are inappropriate during pregnancy, may interact with medications or other supplements, may have side effects of their own, or may contain potentially harmful ingredients not listed on the label. I also understand that most supplements have not been tested in pregnant women, nursing mothers, or children. Potential risks include but are not limited to: allergic reactions, nausea, gas, stomachache, vomiting, headache, diarrhea, rash, hives and tingling of the tongue. Some possible side effects of applying topical creams, liniments, ointments and plasters are rashes, hives and tingling of the skin. I will immediately notify my physician of any experienced unanticipated or unpleasant effects associated with the consumption of herbal teas, tinctures, topical creams, or patent (pill form) medicines.
I understand that physicians of Precision Integrative Medicine, LLC cannot be expected to be able to anticipate and explain all risks and complications. I understand and agree that my physician will exercise judgment during the course of treatment which they feel at the time, based on the facts known then, is in the best interest of me as the patient. Medicine is very complex. New research and experience constantly provide beneficial changes in diagnosis and treatment. Although every physician wishes to do their best, no physician can guarantee a cure or promise a perfect result in every case.
Potential benefits of treatment include but are not limited to: restoration of health and the body’s maximal functional capacity without the use of drugs or surgery; relief of pain and symptoms of disease; assistance in injury and disease recovery; and prevention of disease or its progression.
Contraindications for certain herbs and/or acupuncture treatment include a history of a bleeding disorder or current anticoagulant therapy, an implanted pacemaker or prosthetic heart valve, use of certain medications, and/or pregnancy.
Notice to pregnant women: All female patients must alert the Precision Integrative Medicine, LLC physician if they know or suspect that they are pregnant as some of the therapies used could present a risk to the pregnancy.
Privacy: I understand that a record will be kept of the health services provided to me. This record will be kept confidential and will not be released to others unless so directed by myself, or my representative, or unless it is required by law.
I understand that Precision Integrative Medicine, LLC physicians act as separate health care providers. Each provider is individually responsible for its own activities. This includes complying with privacy laws and all health care services it provides. Precision Integrative Medicine, LLC physicians are not providing health care services mutually or on each other’s behalf. Precision Integrative Medicine, LLC providers may share health information as allowed by law or as permitted by me.
I understand that Precision Integrative Medicine, LLC applies reasonable safeguards to protect my Personal Health Information, however, due to the size of the clinic and the semi-private rooms, I understand that an incidental disclosure may occur. I understand that if there is a medical emergency following treatment, I will call 911.