CAM (Complementary and Alternative Medicine) consent form
CAM Recommendations:
– Supplements – see receipt, test results, office note, office form.
– IV Therapy – see attached receipt.
– Injections – see attached receipt.
– Nutrition counseling.
– Dynamic Thermography.
– A.R.T. (Autonomic Response Therapy).
– PEMF (Pulsed Electronic Magnetic Frequency).
– Other: See office, office form, test results.
The Center for Integrative Medicine offers Complementary and Alternative Medicine (CAM) to our patients. CAM therapies mean those health care methods of diagnosis, treatment, or healing that are not generally used but that provide a reasonable potential for therapeutic gain in a patient’s medical condition that is not outweighed by the risk of the health care method. CAM therapies may include, but are not limited to, the use of FDA approved therapies prescribed in non-FDA approved, off-label, alternative lengths of therapy, alternative dosing schedules, alternative does recommendations, and pharmaceutically compounded treatments. CAM diagnostics may also include the non-FDA and/or non-traditionally sanctioned interpretation of both FDA and non-FDA approved medical imaging and laboratory testing.
Michael Hirt, MD, is a Medical Doctor who is trained in specific CAM therapies and diagnostics. Dr. Hirt obtained his medical degree from Harvard Medical School and completed his post-doctoral training in Internal Medicine at the U.C.L.A Medical Center. Following this training, Dr. Hirt became board certified in Nutrition by the American Board of Nutrition. Dr. Hirt continues to train in CAM therapies and diagnostics which augment the traditional medical evaluation and therapies that are offered to his patients.
Regarding any and all of your medical conditions and diagnoses presented to you by Dr. Hirt, Dr. Hirt’s representatives, or any other CAM healthcare practitioner, you are encouraged to seek additional medical opinions and therapeutic options in the traditional medical care model without delay before deciding on a course of action.
The State of California statutorily recognizes the value of CAM therapies (§2234.1): Since the National Institute of Medicine has reported that it can take up to 17 years for a new best practice to reach the average physician and surgeon, it is prudent to give attention to developments not only in general medical care but in the actual treatment of specific diseases, particularly those that are not yet broadly recognized in California.
Your purchase today indicates (1) your willing ness to receive CAM therapy and/or diagnostics based on the recommendations of Michael Hirt, MD and/or his representatives; (2) that your questions/concerns regarding any and all CAM medical care recommendations have been satisfactorily addressed; (3) and that the relevant risk, benefits and alternatives of the recommended therapy(ies) have been satisfactorily reviewed. Further, before commencing with the CAM recommendations, you acknowledge that you have had an opportunity or may pursue the opportunity, at your sole discretion and direction, to seek other traditional medical opinions and evaluate other traditional medical therapies for your conditions(s).