Louisiana Administrative Code
Title 46 - PROFESSIONAL AND OCCUPATIONAL STANDARDS
Part LXIII - Psychologists
Subpart 1 - General Provisions
Chapter 21 - Disclosure of Financial Interests and Prohibited Payments
Subchapter A - Disclosure of Financial Interest in Third-Party Health Care Providers
Section LXIII-2109 - Form of Disclosure

Universal Citation: LA Admin Code LXIII-2109

Current through Register Vol. 50, No. 9, September 20, 2024

A. Required Contents. The disclosure required by §2105 of this Chapter shall be made in writing, shall be furnished to the patient, or the patient's authorized representative, prior to or at the time of making the referral, and shall include:

1. the psychologist's name, address and phone number;

2. the name and address of the health care provider to whom the patient is being referred by the psychologist;

3. the nature of the items or services which the patient is to receive from the health care provider to which the patient is being referred; and

4. the existence and nature of the psychologist's financial interest in the health care provider to whom or to which the patient is being referred.

B. Permissible Contents. The form of disclosure required by §2105 of this Chapter may include a signed acknowledgment by the patient or the patient's authorized representative that the required disclosure has been given.

C. Approved Form. Notice to a patient given substantially in the form of Disclosure of Financial Interest, found at the end of this Chapter, shall be presumptively deemed to satisfy the disclosure requirements of this Subchapter.

AUTHORITY NOTE: Promulgated in accordance with R.S. 37:1744 and R.S. 37:1745.

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