Informed Consent
In Person Treatment
Doctors of Chiropractic that perform manual therapy techniques, active care exercises, kinesio-taping, cryotherapy, and spinal manipulation should advise patient that as with any healthcare procedure, there are or may be some risks associated with such treatment. These complications include but are not limited to:
Manual Therapy, Myofascial Release: This treatment involves a licensed health care provider's hands or instrument applying pressure on muscle tissue and manipulating joints. In particular, myofascial release involves sustained pressure into myofascial, connective tissue restrictions.
Benefits: The benefits of manual therapy and myofascial release is to restore normal tissue functions, joint function, and aid in normal musculoskeletal biomechanics as well as decrease pain levels, speed recovery, and restore range of motion.
Risks include localized discomfort, skin reddening, superficial tissue bruising, release of emboli (rare), symptoms shifting to different body areas, post treatment soreness, and/or increase in pain.
Alternatives to care included prescribed and over-the-counter medication, joint or soft tissue injections performed by a physician, and rest
Active Rehabilitation Exercises: Active care and corrective rehabilitations exercises consists of active participation of the patient to perform certain exercises to help facilitate healing. Exercises prescribed include, but are not limited to, functional movements, stretches, selfmyofascial release, and open and closed chain exercises.
Benefits: Active care and corrective exercises are prescribed for the sole purpose of facilitating appropriate mobility or stability within the musculoskeletal system. These exercises are designed to help healing during treatment and prevent pain from returning after discharge.
Risks include aggravation of a present condition, blood pressure changes, and increased heart rate.
Alternatives include prescribed and over-the-counter medication, joint or soft tissue injections performed by a physician, and rest
Kinesio-Taping: Kinesio-taping is specialized taping of areas of the body.
Benefits: May aid normal muscle movement and provide stability by mimicking the effects of bracing.
Risks: The risks of kinesis-taping include skin reactions, such as itching, allergic reactions, hyper pigmentation (discoloration), and blistering.
Alternatives: include icing, bracing, athletic taping, and ace bandaging.
Cryotherapy (ice): Exposure to subzero temperatures to decrease inflammation.
Benefits: Can aid in decreasing muscle soreness, stiffness, and bruising.
Risks: Include skin reactions, such as itching, allergic reactions, burning, hyper pigmentation (discoloration), and blistering.
Alternatives: prescribed and over-the-counter medication, joint or soft tissue injections performed by a physician, and rest.
Spinal Manipulation: Adjustments and manipulation to the spine are thrusts applied to the vertebra and contiguous structures.
Benefits: Spinal manipulation can help restore normal spinal joint movement, increase stability, decrease pain, and correct vertebral subluxation complex.
Risks include fractures, disc injuries, dislocations, muscle strain, and post treatment soreness. Some types of manipulation of the neck have been associated with injuries to the arteries in the neck leading to or contributing to serious complications including stroke.
Alternatives include prescribed and over-the-counter medication, joint or soft tissue injections performed by a physician, and rest
In addition, I recognize the nature of my injury may require the provider to perform examination and treatment near or around sensitive areas, i.e. chest, groin, buttocks, etc., and the provider will make every effort to safeguard my modesty.
The Doctor will make every reasonable effort during the examination to screen for contraindications to care; however, if you have a condition that would otherwise not come to the Doctor’s attention it is your responsibility to inform the Doctor. I do not expect my Doctor to be able to anticipate and explain all risks/complications. Further, I wish to rely on their professional and clinical judgement during the course of treatment which the Doctor feels are in my best interests, based upon the facts then known.
Telehealth Treatment
Complete Muscle Recovery may utilize Telehealth to allow ability to provide diagnosis, therapy, follow-up and/or education to you from any location. Telehealth, involves the use of electronic communications that is intended to improve patient care through efficient medical evaluations and management. The information may include any of the following:
• Patient medical records
• Medical images
• Live two-way audio and video
• Output data from medical devices and sound and video files
Electronic systems used will incorporate network and software security protocols to protect the confidentiality of patient identification and imaging data and will include measures to safeguard the data and its integrity against intentional and unintentional corruption. Complete Muscle Recovery will not record or store electronic communications provided during Telehealth interactions.
The informed consent documents are used to communicate information about Telehealth along with disclosure of risks. The informed consent documents should not be considered all inclusive in describing Telehealth and all potential risks. The potential risks of Telehealth include, but may not be limited to:
• In rare cases, information transmitted may not be sufficient (e.g., poor resolution of images) to allow for appropriate medical decision making by the Complete Muscle Recovery provider;
• Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment;
• In very rare instances, security protocols could fail, causing a breach of privacy of personal medical information;
• In rare cases, a lack of access to complete medical records may result in adverse drug interactions or allergic reactions or other judgment errors.
I have had the opportunity to ask questions and express concerns prior to treatment. I do not expect my Complete Muscle Recovery provider to be able to anticipate and explain all risks and complications of Telehealth.
Text Message and Email Communication
Complete Muscle Recovery may communicate with you via text message and/or email to allow for more efficient and expedited feedback from your provider. The text messages and emails may contain protected health information. The transmission and storage of the test messages and emails may or may not be encrypted or secured.
The informed consent documents are used to explain communications via text message and email along with disclosing applicable risks. The informed consent documents should not be considered all-inclusive in describing all potential risks. The potential risks may include, but may not be limited to:
• The transmission of information may fail, be delayed or unclear (ex: problematic or delayed electronic transmission of the information); or
• The communication may be insecure or security protocols could fail, causing a breach of personal an protected health information.