Physician Qualification and Liability: Firearms Safety and Counseling Representation

[High Exposure 5,680]

I thought this was pretty good.

 

Print it out and bring it to your next Dr appointment. If they start asking about firearms in your home, hand it over and ask the Doc to sign it.

 

http://www.pnwgamer.info/gun_doc_form.pdf

 

Part One: Qualifications

PHYSICIAN QUALIFICATIONS AND LIABILITY

FIREARMS SAFETY COUNSELING REPRESENTATION:

I affirm that I am certified to offer (Name of Patient: ), herineafter referred to as "the Patient", qualified advice about firearms safety in the home, having received:

Specify Course(s) of Study: _________________________________________________________________________ from:

Specify Institution(s) _________________________________________________________________________ on:

Specify Course Completion Date(s): _________________________________________________________________________ resulting in:

Specify Accreditation(s), Certification(s), License(s) etc.: _________________________________________________________________________

_________________________________________________________________________

Check one, as appropriate:

___ I represent that I have reviewed applicable scientific literature pertaining to defensive gun use and beneficial results of private firearms ownership. I further represent that I have reviewed all other relevant home safety issues with the Patient, including those relating to electricity, drains, disposals, compactors, garage doors, driveway safety, pool safety, pool fence codes and special locks for pool gates, auto safety, gas, broken glass, stored cleaning chemicals, buckets, toilets, sharp objects, garden tools, home tools, power tools, lawnmowers, lawn chemicals, scissors, needles, forks, knives, etc. I also acknowledge, by receiving this document, I have been made aware that, in his inaugural address before the American Medical Association on June 20, 2001, new president Richard Corlin, MD, admitted "What we don't know about violence and guns is literally killing us...researchers do not have the data to tell how kids get guns, if trigger locks work, what the warning signs of violence in schools and at the workplace are and other critical questions due to lack of research funding." (UPI). In spite of this admission, I represent that I have sufficient data and expertise to provide expert and clinically sound advice to patients regarding firearms in the home.

OR

___ I am knowingly engaging in Home/Firearms Safety Counseling without certification, license or formal training in Risk Management, and; I have not reviewed applicable scientific literature pertaining to defensive gun use and beneficial results of private firearms ownership.

Part Two: Liability

I have determined, from a review of my medical malpractice insurance, that if I engage in an activity for which I am not certified, such as Firearms Safety Counseling, the carrier (check one, as appropriate):

___ will

___ will not

cover lawsuits resulting from neglect, lack of qualification, etc.

Insurance Carrier name, address and policy number insuring me for firearms safety expertise:

_________________________________________________________________________

I further warrant that, should the Patient follow my firearm safety counseling and remove from the home and/or disable firearms with trigger locks or other mechanisms, and if the patient or a family member, friend or visitor is subsequently injured or killed as a result of said removal or disabling, that my malpractice insurance and/or personal assets will cover all actual and punitive damages resulting from a lawsuit initiated by the patient, the patient's legal reprerentative, or the patient's survivors.

Signature of attesting physician and date: __________________________________________________

Name of attesting physician (please print):__________________________________________________

Signature of patient and date: ____________________________________________________________

Name of patient (please print):____________________________________________________________

Patient: Indicate if physician "REFUSED TO SIGN." Have physician place a copy in your chart/medical record.

ETA: fixed link and added page 1 of the document to post.

Edited May 15, 2013 by High Exposure
fixed the link

[TheLugNutZ 21]

broken URL for me.  Might just be b/c its a blocked site at work for me tho, but it doesnt seem like it...

[T Bill 649]

Link no work!

[High Exposure 5,680]

Try it now. Thanks for the heads up

[NYMetsFan86 9]

saved that form thanks

[TheLugNutZ 21]

thats great

[fishnut 2,358]

This is great! My blood boils every time they ask if I have guns in the home. I am going to make a DR appointment just so I can hand this over when they ask!

[Wolfjon 0]

Do Dr.s actually ask this? I have never had my my Dr ask anything about guns..   On a side note I have been thinking about going to the eye Dr to try and improve my shooting..LOL

[checko 180]

I wouldnt answer that. Has anyone been asked this?

[GRIZ 3,369]

Good thing to have "just in case".

 

I've never had a Dr ask me this directly. "Do you own guns" was on a lifestyle profile I had to fill out as part of a physical for the military during the Clinton years for the military. When you got the assessment back it told you to stay away from guns or you could get hurt. This was when your job meant you could be blown to pieces by artillery, vaporized by a nuclear weapon, or die an agonizing death from chemical or biological weapons. Go figure.

 

You could be lucky though and wind up taking one of your doctors shooting.

[wooly bugger 1]

I've never been asked, but if I were, my answer would be: "If I did keep guns in the home, they would be kept unloaded in a 700 pound safe, which only my wife and I have the combination to."

 

In their defense, not all doctors are asking these questions to pry. They're often held to "quality standards," which they hate as much as we do. Things like, "do you wear seatbelts," "do you have fire detectors." It's not their agenda, it's the agenda of the leftist professional societies. They resent being used as clipboard-bearing survey takers.

[Howard 538]

I've never been asked such a question.  Any time there is info on a form at a doctors office that I don't consider germane I just leave it blank, if they ever ask why I tell them I don't want to participate in their unpaid research project.

[raz-0 1,261]

Nope primary didn't ask. Had a question for the pediatrician that lead to mentioning guns. He was aggressively more concerned about us being careful about water temps and not scalding the baby. You can guess what he sees a heck of a lot more kids in his office for.

[ECShooter 0]

I went to see an endocrinologist for a "glandular" evaluation and was asked about sex with prostitutes, male prostitutes, female prostitutes, animals, condom use, giving oral, receiving oral, lactation fetishes, giving and receiving anal, vaginal, belly buttonal, wearing flip flops, changing my socks, past exposure to stds, type of underwear, sunscreen use, etc... Nothing about firearms.

 

Funny thing, it was a thyroid issue, I didn't know that my apparel and sex life were indications of a thyroid issue. He has a picture of himself with a harvested elk and his bolt action rifle on the wall under his diplomas, so I don't think he cared about firearms.

 

No thyroid issue, turns out I was just chubby from over eating.

 

This is an awesome doc, thanks for posting. I will have it handy next time I visit any doctor for myself or family members.

 

 

Sent from my iPad using Tapatalk HD

[Night Prowler 0]

What, wtf belly buttonal? Are you for real? That's just funny!

[Damjan 73]

I went to see an endocrinologist for a "glandular" evaluation and was asked about sex with prostitutes, male prostitutes, female prostitutes, animals, condom use, giving oral, receiving oral, lactation fetishes, giving and receiving anal, vaginal, belly buttonal, wearing flip flops, changing my socks, past exposure to stds, type of underwear, sunscreen use, etc... Nothing about firearms. Funny thing, it was a thyroid issue, I didn't know that my apparel and sex life were indications of a thyroid issue. He has a picture of himself with a harvested elk and his bolt action rifle on the wall under his diplomas, so I don't think he cared about firearms.No thyroid issue, turns out I was just chubby from over eating.This is an awesome doc, thanks for posting. I will have it handy next time I visit any doctor for myself or family members.Sent from my iPad using Tapatalk HD

Wow,

What a thorough doc.

Are you sure he wasnt satisfying a fetish of his?

[ECShooter 0]

Halfway through I literally said "What the fu..? Dude are you serious?" he cracked up laughing. Thorough, but weird. I would have worried if he insisted on a rectal exam.

[Damjan 73]

Halfway through I literally said "What the fu..? Dude are you serious?" he cracked up laughing. Thorough, but weird. I would have worried if he insisted on a rectal exam.

Maybe he did it, but you dont remember because of the roofie :) :)

[ECShooter 0]

Wouldn't be the first time!

[Damjan 73]

Wouldn't be the first time!

 

......hahahhahahaha........good one.......

[1LtCAP 4,267]

can they refuse treatment if you refuse to answer any of the questions? 'cause to be honest........i don't see myself answering anything that doesn't directly relate to why i'm there.

[wooly bugger 1]

can they refuse treatment if you refuse to answer any of the questions? 'cause to be honest........i don't see myself answering anything that doesn't directly relate to why i'm there.

no

[Fawkesguy 57]

can they refuse treatment if you refuse to answer any of the questions? 'cause to be honest........i don't see myself answering anything that doesn't directly relate to why i'm there.

 

Nope.  The last several times either I or an immediate family member has gotten a physical, we've been handed (among other forms) a questionnaire entitled "Environmental Scan".  That's the form that asks about firearms in the home.  The first time I got it, I asked if it was required info.  The Dr. said no, so I either refuse to fill it out, or simply mark the irrelevant sections "N/A".  Sometimes part of the form asks about family medical history, so I fill that out.  I feel that the sections that ask about my personal possessions are incredibly intrusive.

[Kingsoverqueens 10]

can they refuse treatment if you refuse to answer any of the questions? 'cause to be honest........i don't see myself answering anything that doesn't directly relate to why i'm there.

There was a case in Florida if memory serves where a Dr. asked his patient to find a new Doctor.  She refused to respond to some questions and he felt uncomfortable treating someone who he felt wasn't being forthcoming with info that might affect his treatment.  He treated her that day and then sent a letter informing her that she needed to get a new Doctor and gave a fairly long period of time to do so.

 

He was sued and prevailed.

 

Doctors are a business and have the right to accept who they want as patients.  Their oath prevents them from denying treatment in an emergency, but as far as cultivating a base of patients, they certainly can refuse someone...discriminatory reasons notwithstanding.

 

As an example my doctor stopped accepting medicare patients in 2006.  I assume if they paid out of pocket she'd see them.

[Fawkesguy 57]

There was a case in Florida if memory serves where a Dr. asked his patient to find a new Doctor.  She refused to respond to some questions and he felt uncomfortable treating someone who he felt wasn't being forthcoming with info that might affect his treatment.  He treated her that day and then sent a letter informing her that she needed to get a new Doctor and gave a fairly long period of time to do so.

 

He was sued and prevailed.

 

Doctors are a business and have the right to accept who they want as patients.  Their oath prevents them from denying treatment in an emergency, but as far as cultivating a base of patients, they certainly can refuse someone...discriminatory reasons notwithstanding.

 

As an example my doctor stopped accepting medicare patients in 2006.  I assume if they paid out of pocket she'd see them.

 

Very interesting.  Well, I suppose it's a case by case thing.  My guess is that most doctors would not refuse to have you as a patient, but my other guess is that most people answer questions like these without a second thought.

[1LtCAP 4,267]

there is no way that inanimate objects in your home can effect their treatment. i'd gladly find another dr if they didn't like me not answering their irrelevant questions.

[DSD1026 48]

yeah, i cant see me ever answering that kind of a question..  unless im getting potential lead poisoning or have shot myself in the foot, a gun in my home has 100% no bearing on medical treatment..    that said, i HIGHLY doubt my doctor would ask.. 

[Parker 213]

The Affordable Care Act leaves the door open on this one. (I first got this question when my daughter started seeing her pediatrician and it was on the "fill out the obligatory information" questionnaire. And that was 18 years ago. Before Obama. Before Obamacare. Before any executive orders.) The five doctors I've seen over the last year have never asked this question of me personally.

 

From Medscape -

http://www.medscape.com/viewarticle/777771

 

Forbes:

http://www.forbes.com/sites/carolynmcclanahan/2012/07/23/gun-owner-rights-and-obamacare-yes-it-is-in-the-law/

 

 

AND I do like that form!

 

 

 

 

 

 

[acuevo 0]

do doctors ask this even to those without kids? when my wife took our son, they asked, but never when i've gone on my own for myself.

 

and really... the only answer you can give is "no". if you make a fuss, or ask if something is really necessary they will know somethings up. so when the question comes they get a "no" response in the same tone as any of my other responses.

[Handyman 5,682]

If a doc is asking this it is just part of a general safety screen as someone noted above. If you don't want to answer just decline - it ain't worth fighting words. Maybe if a pediatrician had once posed a question a 4 year-old would not have been able to shoot a 6 year-old in the head a month ago.