Pennsylvania Code
Title 49 - PROFESSIONAL AND VOCATIONAL STANDARDS
Part I - DEPARTMENT OF STATE
Subpart A - PROFESSIONAL AND OCCUPATIONAL AFFAIRS
Chapter 45 - STATE BOARD OF EXAMINERS IN SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY
Subchapter A - GENERAL PROVISIONS
Section 45.3 - Disclosure of financial or ownership interest-statement of policy
Current through Register Vol. 54, No. 52, December 28, 2024
(a) Purpose. This statement of policy implements the act of May 26, 1988 (P. L. 403, No. 66) (35 P. S. §§ 449.21-449.23).
(b) Requirement. A licensee of the Board referring a client for health-related services, devices or products to a business, service provider, facility or entity in which the licensee or a member of his family has a financial or ownership interest to any extent or degree, shall disclose that interest prior to making the referral, and shall notify the client of his freedom to choose an alternate provider.
(c) Guidelines for disclosure.
TREATMENT IN THIS OFFICE MAY INCLUDE A REFERRAL FOR FURTHER HEALTH-RELATED SERVICES, DEVICES OR PRODUCTS. PENNSYLVANIA LAW REQUIRES ANY HEALTH-CARE PRACTITIONER TO DISCLOSE TO YOU ANY FINANCIAL INTEREST HE HAS IN ANY HEALTH-CARE FACILITY IN WHICH HE RECOMMENDS FURTHER HEALTH-RELATED SERVICES, DEVICES OR PRODUCTS. (ACT 66-1988)"
I have been referred to ____________ for ____________ . I understand that my [licensee's profession] has a financial interest in this business, and that I am free to choose an alternate provider.
_________________________
(signature of patient)