20 CSR 2150-5.030
Physical Therapy, Rehabilitation Services, or Both
PURPOSE: This rule provides information concerning the disclosure
of a physician’s pecuniary interest in a physical therapy or
rehabilitation service as directed by section 334.100.2(21), RSMo.
(1) Pursuant to the authority granted in section 334.100.2(21),
RSMo, physicians who have a pecuniary interest in physical
therapy or rehabilitation service facilities must disclose that
interest to patients who are prescribed either physical therapy
or rehabilitation services using the following form:
Missouri state law, 334.100.2(21), RSMo, requires a physician
notify the patient or guardian that the physician has
a pecuniary (financial) interest in the physical therapy
facility in which prescribed treatment is provided, and that
physical therapy or rehabilitation services are available to
the patient on a competitive basis from other facilities.
Therefore, I understand that Dr.__________________________
has a financial interest in ________________________facility.
Further, I understand that I have the right to choose any other
physical therapy or rehabilitation services which may be more
convenient or competitive.
_________________________
Patient/Guardian Signature
_________________________
Date
This should be retained in the patient’s permanent record.
AUTHORITY: sections 334.100.2(21), RSMo Supp. 1990 and 334.125,
RSMo 1986.* This rule originally filed as 4 CSR 150-5.030. Original
rule filed April 4, 1990, effective Nov. 30, 1990. Moved to 20 CSR
2150-5.030, effective Aug. 28, 2006.
*Original authority: 334.100.2(21), RSMo 1939, amended 1945, 1959, 1963, 1974, 1976,
1979, 1981, 1983, 1984, 1986, 1987, 1989, 1990 and 334.125, RSMo 1959.