Thank you for choosing to make an appointment with me, Dr Brad Beira.
Consent in the context of a clinical contract between a healthcare professional and a patient is the process of sharing information between the persons so that there is a mutual understanding of what is to be expected.
The process of informed consent is done to respect the professional relationship between the healthcare practitioner and the patient and answer all questions that the person may have about the hazards, potential complications and risks of both their medical condition and the corresponding risks of the assessment and treatment of that condition.
To follow is the general consent that would define the terms of our professional engagement in understanding your health situation and defining the most appropriate treatment plan.Managed Consent
I understand that I have the right to confidentiality of my personal health information. These rights are given to me in terms of the South African Constitution, the National Health Act and the Protection of Personal Information Act.
All confidential information shared between myself and Dr Brad Beira during clinical consultations will be managed in accordance with the requirements of the National Health Act and all Allied Health Professions Council of South Africa (AHPCSA) guidelines as published and amended from time to time.
Digital recording of the consultation is my right in terms of the Regulation of Interception of Communications and Provision of Communication related Information Act.
I acknowledge that it is requested that I share this intention to make a digital recording of the consultation prior to the commencement of the consultation.
In each case, prior to any Assessment or Chiropractic procedure being undertaken, a detailed explanation of the hazards, risks, outcomes and potential complications of the assessment and/or procedure will be explained in detail.
Where practical, digital links to detailed explanations will be provided for educational and information purposes.Duty to Disclose
It is your responsibility to disclose all health and wellness related information that you know, or could reasonably be expected to know including but not limited to both accurate descriptions and details of your symptoms, the mechanism of injury - if an injury occurred, all allergies, previous injuries, surgeries, other treatment and all medications that you are taking.
This information is relevant to assist Dr Brad Beira's clinically informed decisions relating to your current and future care during your consultations.
I understand that
- I may restrict the use of my personal health information by Dr Brad Beira as I deem fit;
- I have the right to limit my consent for the use of my personal health information in sharing with other healthcare practitioners, my employer or other third parties. This must be confirmed in writing, should I so decide;
- All information or disclosure that occurred prior to my date of waiver shall not be affected by such waiver;
- Chiropractic manipulative therapy carries with it certain risks that may result in temporary or permanent adverse outcomes which may affect me physically, physiologically and/or emotionally. These hazards, complications and their risks will be fully explained to me prior to any treatment being undertaken;
- Your specific treatment plan, appropriate for my condition will be explained to me, as will all risks pertinent to such a treatment plan;
- Telehealth and communication using digital platforms are a reality in our modern context of accessing healthcare services. Every effort will be taken to limit the use of Whatsapp communication as a form of sharing personal clinical information;
and that by engaging in the treatment plan I accept and authorize Dr Brad Beira to commence with and continue agreed upon treatment until such time as my condition resolves, or I voluntarily decide to discontinue treatment.
By making this appointment, I (or in the case of a minor - I, the Parent/legal guardian) authorize Dr Brad Beira, as may be necessary from time to time:
- to perform appropriate examinations, therapies and procedures that are pertinent to my care, and
- to obtain payment from either myself, my parent , guardian or the relevant third party payer if required.
Thank you in advance for your confidence and trust.
Dr. Brad Beira