Truth in Care Statement

Welcome to our practice.

We are pleased that you have chosen us for your care and we will do our best to be sure your experience meets your expectations. We would, of course, like to exceed your expectations, but we have no clue how we could possibly do that and still stay in practice, given what we are being paid.

As part of our efforts to provide conflict of interest transparency, we require, before the feds do, that you sign this Truth in Care Statement.

I , __________, understand that:

1. My doctor has many conflicts of interest

2. Those conflicts of interest include, but are not limited to personal prejudices and subconscious biases

3. My doctor a) works for someone else ___ or b) is self-employed in fee-for-service medicine__ (please check appropriate box) and that either represents a conflict of interest.

4. While I understand and expect that my interests as the patient will be primary and other interests will be secondary, there is no way for me to get the necessary information I need to validate that nor do I expect my doctor to provide it to me on a regular basis

5. I understand that potential conflicts exist when my doctor participates in entrepreneurial ventures, gets paid by industry, is a member of hospital based committees charged with rationally rationing care, acts as an agent of an employer, payer, or government agency, or is being held accountable to optimize societal resources.

6. For the above reasons, I will hold harmless my provider for legal, undisclosed conflicts of interest

Signed, this day ____________

_____________________________

Thank you again for the trust you have bestowed in our practice. We look forward to serving you and your family. Since I will be on a hypertensive drug speakers bureau tour for the next several weeks, please schedule your appointment sufficiently far in advance.