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Record Keeping and Patient Attestation of the Importance of Consulting a Licensed Physician

Education Law Section 8211 requires that licensed acupuncturists  advise each patient as to the importance of consulting with a licensed physician regarding the patient’s condition and must keep on file with the patient’s records, a form attesting to the patient’s notice of such advice. The form must be in duplicate, one copy to be retained by the patient, signed and dated by both the acupuncturist and the patient. The attestation should include the below language:


WE, THE UNDERSIGNED, DO AFFIRM THAT ______________________(THE PATIENT) HAS BEEN ADVISED BY_______________________, (A LICENSED ACUPUNCTURIST), TO CONSULT A PHYSICIAN REGARDING THE CONDITION OR CONDITIONS FOR WHICH SUCH PATIENT SEEKS ACUPUNCTURE TREATMENT.


____________________________________    _____________________
(Signature)                                         (Date)


____________________________________    _____________________
(Signature)                                         (Date)

Please note, this attestation does not need to be a separate form; however, it must be clearly attested to with the patient’s full understanding of the recommendation. The attestation may not be deeply embedded within another form or difficult to locate. At a minimum, a signed copy must be provided to the patient for their personal records, and a signed copy must remain within the patient’s record.