DISCLAIMER POLICIES & HIPPA FORM 2024
Welcome to wellness integration at Holistic Healthship, Inc., and Natural Health Strategies with Dr. Keri Brown. In Naturopathic Medicine, we focus on treating the whole person or bio terrain to help restore health from the ground up. We focus on supporting the body, mind, and spirit that affects health and organ function concerning stress, injury, disease, or trauma. We consider the interconnection of all health issues and underlying problems and put the big picture together for recovery and wellness. Dr. Brown approaches your health to treat the causes and thus improve function. In choosing this approach, you combine complementary and alternative medicine methods for self-healing. Naturopathic Medicine is based on science from medical literature and historical knowledge of natural medicine, traditional healing wisdom, and natural cures. Dr. Brown has been practicing since 1998.
FINANCIAL POLICY
I understand that payment in full is expected at the time of services. I agree to pay for all services. I understand that my insurance HSA and FSA credit cards may be used )or not) and reimbursable for services and tests. I acknowledge that I am responsible for this account. I acknowledge that while I may terminate care at any time, no refunds are available for any care I have received. I agree to take full financial responsibility for appointments not canceled or rescheduled at least 48 hours in advance by making full payment for that scheduled appointment.
Appointment cancellation must be done within 48 hours before your appointment. You can go to your Square appointment reminder to cancel.
To remain a continuing client of Dr. Brown, clients must see Dr. Brown once every six months. If a longer period has laps, a new client intake must be conducted to assess your health fully.
DOCTOR-PATIENT RELATIONSHIP
I understand that Dr. Brown offers the service of natural health and wellness consulting as a Naturopathic Doctor on an outpatient, by-appointment basis. I understand that Dr. Brown is never available on an emergency basis, offers consultation services on a formal in-office or by-phone appointment basis only, and is neither available by pager, cell phone, or internet in-between formal consultation appointments, that questions about care and protocol changes will be handled within the confines of a formal appointment unless otherwise agreed upon. I understand that Dr. Brown is licensed as a Naturopathic Doctor in CO.
NATUROPATHIC & FUNCTIONAL MEDICINE CONSULTATIONS
The length of the initial consultation is based on the complexity of your health. Additional time will be added based on the complexity of your state of health.
The length of the first follow-up appointment is determined by Dr. Brown at the time of your new patient visit and is based on the complexity of your state of health.
If you are getting lab testing, the length of the first follow-up appointment will be determined to review the test results. Emails are answered on hourly billable time in 5-minute intervals to the credit card on file.
LAB TESTS
We use DirectLabs.com for blood work. If you have insurance, you are encouraged to get your MD to conduct your lab work. We will provide you with a lab requisition that you can then order from directlabs.com. You will then be responsible for scheduling your blood draw through their website. PLEASE ARRIVE FASTING – and bring your requisition to your appointment. Some labs that involve stool, urine, or saliva samples are done at home and sent from various companies. During your consultation, you will receive information and instructions for at-home tests. All lab results will be reviewed with you during your follow-up appointment.
PHONE CALLS AND MESSAGES
When leaving a message or Text Massage, please include the following information:
Full name, spell your last name
Phone number(s)
PRIMARY CARE PHYSICIAN
Please note that Dr. Keri Brown, N.D., does not act as a primary care physician or facility. We recommend that you have a primary care physician in times of emergencies.
The state registers naturopathic Doctors to practice naturopathic Medicine under the "Naturopathic Doctor Act." They are not permitted to perform the following acts:
- Prescribe, dispense, administer, or inject any prescription medications or devices other than epinephrine for anaphylaxis and barrier contraceptives (not including IUDs).
- Perform surgical procedures, including surgical procedures using a laser device.
- Use general or spinal anesthetics other than topical anesthetics.
Administer ionizing radioactive substances for therapeutic purposes.
- Treat a child who is less than two years old.
- Treat a child who is two years of age or older but less than eight years of age unless: (1) this.
- The form is fully completed and signed; (2) the most recent immunization schedule recommended by The advisory committee on immunization practices to the Centers for disease control and Prevention in the Federal Department of health and Human Services is provided to the parent or guardian with this form, and (3) a release of information requests permission to exchange information with the child's licensed pediatric health care provider if the child has one.
- Practice medicine, surgery, or any form of healing other than Naturopathic Medicine.
- Practice obstetrics. Perform chiropractic services (spinal adjustments, manipulation, or mobilization).
- Recommend discontinuing or counsel against a course of care, including a prescription drug recommended by another health care practitioner licensed in Colorado, unless the Naturopathic Doctor consults with the health care practitioner.
CONSULTATION EXCLUSIONS
File a complaint if you feel we have violated your rights by contacting: 1103 Oak Park Drive, Fort Collins, CO 80525, (970) 237-1062; or U.S. Department of Health and Human Services Office for Civil Rights, 200 Independence Ave, S.W. Washington, D.C. 20201, 1-877-696-6775, www.hhs.gov/ocr/privacy/hipaa/complaints.
CREDENTIALS
Dr. Keri Brown, ND, is a registered naturopathic doctor registered in the state of Colorado ND-000079. Dr. Brown is a 1998 graduate of Bastyr University, WA, holding a doctorate in Naturopathic Medicine, and a 1988 graduate of Fort Lewis College, CO, with a B.S. in Environmental Biology and Chemistry.
REGARDING EMAILS
Informed Consent Regarding Email or the Internet Use of Protected Personal Information
HH Consulting allows you to communicate with them by email. However, transmitting confidential health information by email has several general and specific risks that should be considered before using email.
1. Risks:
a. email can be immediately broadcast worldwide and be received by many intended and unintended recipients.
b. Specific email risks are the following: email containing information about diagnosis and treatment must be included in the protected personal health information; all individuals with access to the protected personal health information will have access to the email messages.
2. It is the policy of HH Consulting that all email messages sent or received that concern the patient's diagnosis or treatment will be a part of that patient's protected personal health information. Because of the risks outlined above, we cannot guarantee the security and confidentiality of email or internet communications.
3. Patients must consent to email for confidential medical information after being informed of the above risks. Consent to the use of email includes an agreement with the following conditions:
a. All emails to or from patients concerning diagnosis and treatment will be part of the protected personal health information. As a part of the protected personal health information, other individuals, physicians, nurses, and upon written authorization, other healthcare providers and insurers will have access to email messages contained in protected personal health information. We will not, however, forward the email outside the practice without the patient's consent, as required by law.
c. email must not be used in a medical emergency. We will endeavor to read emails promptly but cannot assure that the recipient of the particular email will read the email message promptly. The sender is responsible for determining whether the intended recipient received the email and when the recipient will respond.
CONSULTING POLICIES
(This form must be signed before the patient's initial examination.)
I acknowledge that I have read, understood, and agree to these policies by signing below. I give full consent to the professionals named above to complete my evaluation and provide treatment as necessary. If I have any questions about the included information or anything related to my treatment, I will discuss this with Dr. Keri Brown or staff as appropriate.
Informed Consent Regarding Email or the Internet Use of Protected Personal Information
I understand the risks and responsibilities associated with the use of email. I agree to assume all risks associated with the help of email.
Use the DRAW tool to sign below.