Golden Gate Optimal Health, LLC.
An Integrative Health Approach to Optimal Wellness in the San Francisco Bay Area

Legal Information & Forms

Last Updated: 2/27/17

 

List the various scopes of practice I have and what each one allows me to do under California Law. 

AB 1147 Enacted Sept. 18, 2014  State Certification of Massage Therapy (CAMTC) http://images.magnetmail.net/images/clients/ABMP_MEM/attach/ab1147chaptered.pdf

http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1147

SB 731 State Certification of Massage Therapy

http://www.leginfo.ca.gov/pub/07-08/bill/sen/sb_0701-0750/sb_731_bill_20080927_chaptered.html

Explain and list my insurance carriers and relevant information pertaining to working with clients in their homes (house calls) or in the community and the related insurance coverage needed. 

Supply a link here to the downloaded proof of insurance documents.

Explain my BA in Pre-Law and what I have education/certifications in regarding the law.

According to the US Department of Health and Human Services, in the state of California, cultural competence training is either required or strongly recommended. 

https://www.thinkculturalhealth.hhs.gov/Content/LegislatingCLAS.asp

Here is the link to the pdf detailing the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care.

https://www.thinkculturalhealth.hhs.gov/pdfs/EnhancedNationalCLASStandards.pdf

I have taken a course called "Diversity: Cultural Competence" on June 10th, 2014 and passed it as my voluntarily compliance with this state legislation's requirement or strong recommendation.  Please see my webpage on this website for a copy of the certificate as proof of my professional training. 

Living in San Francisco and being born and raised here, I am very comfortable interacting with different cultures.  It's one of the most enjoyable aspects of life in SF.  I welcome all cultures as potential clients regardless of race, religion, sexual orientation, or any other demographic.  At the same time, I do reserve the right to refuse service to anyone.  I provide all forms in English and Spanish as these are the predominant languages in California.  I can translate as needed via an language translation app on my phone.  I am working on improving my basic conversational Spanish and Cantonese.

Gender Sensitive Massage Intake/History Form:

http://GenderSensitiveMassageIntakeForm.pdf

Sohen-Moe Associates provides three forms translated from English to Spanish:

https://sohnen-moe.com/forms.php#clirec

Massage Therapy Informed Consent (English) https://sohnen-moe.com/download-file.php?f=ma_cnsnt.pdf

Massage Therapy Informed Consent (Spanish) https://sohnen-moe.com/download-file.php?f=ma_cnsnt-es.pdf

Client Status Report (English) https://sohnen-moe.com/download-file.php?f=clntstat.pdf

Client Status Report (Spanish) https://sohnen-moe.com/download-file.php?f=clntstat-es.pdf

Client Health Information Sheet (English) https://sohnen-moe.com/download-file.php?f=clnhelth.pdf

Client Health Information Sheet (Spanish) https://sohnen-moe.com/download-file.php?f=clnhelth-es.pdf

Additional Resources addressing cultural competence:

Health Resources and Services Administration (HRSA)

http://www.hrsa.gov/culturalcompetence/index.html

Enhancing Your Cultural Communication Skills

http://www.med.umich.edu/pteducation/cultcomp.htm

First Time Client Health History Form in English
http://www.abmp.com/img/members/client_treatment/health_information.pdf

First Time Client Health History Form en Espanol 
http://www.abmp.com/img/members/client_treatment/client_information_spanish.pdf


Screening Questionnaire 
http://www.abmp.com/img/members/client_treatment/screening_questionnaire.pdf

Health Status Update (For Returning Clients) 
http://www.abmp.com/img/members/client_treatment/health_status_update.pdf

DVT Assessment Screening Form.  (Used with obtained written permission by Dr. J. Caprini)  DVT Screening Form.pdf

Body Map 
http://www.abmp.com/img/members/client_treatment/body_map.pdf

Physician or Health Care Provider`s Permisson 
http://www.abmp.com/img/members/client_treatment/physician_permission.pdf

Physician or Health Care Provider`s Referral 
http://www.abmp.com/img/members/client_treatment/physician_referral.pdf

Parental Consent
https://www.ascpskincare.com/img/members/Forms/ParentalConsentForm.pdf

Client Feedback
http://www.abmp.com/members/biz_fit/client_feedback_form.pdf

Office Policies 
http://www.abmp.com/img/members/client_treatment/office_policies.pdf

Termination of Care 
http://www.abmp.com/img/members/client_treatment/termination_of_care.pdf

Guidelines for Public Demonstrations and Volunteering  http://www.abmp.com/img/members/client_treatment/guidelines_for_public_demonstrations.pdf

Insurance Billing Information 
http://www.abmp.com/img/members/client_treatment/billing_information.pdf

SOAP Notes 
http://www.abmp.com/img/members/client_treatment/soap_notes.pdf

REFLEXOLOGY FORMS

Client Information Form (pages 1 and 2):

Reflexology Client Info Form.pdf

Medical Information Form (pages 1 and 2):

Reflexology Medical Info Form.pdf

Reflexologist-Client Agreements Form:

Reflexology-Client Agreements Form.pdf

Minor Consent Form:

Reflexology Minor Consent Form.pdf

Client Success Story Form:

Reflexology Client Success Story.pdf

Reflexology Session Forms 1-3:

Reflexology Session Forms 1-3.pdf

Reflexology Session Notes Form:

Reflexology Session Notes.pdf

This is also the legal page that will communicate to the public about my business and what it is about.  It will be the resource to fall back on as well.  It should also list my insurance information and any memberships or associations I am professionally affiliated with.  It should communicate legitimacy and integrity. 

Include a form of consent to be part of research studies.

DISCLAIMERS & CLIENT INTAKE/UPDATE FORMS:

(TO BE COMPLETED PRIOR TO RECEIVING THERAPEUTIC HEALTH SERVICES)

     Make links to word documents that spell out these in 3 main languages:  English, Spanish, and Cantonese.  Include all my disclaimers and client intake forms and info forms here as links to word documents in all three languages, or if not 3, at least English and Spanish.

 Include the underlined portion in all ad materials.

As a Certified Massage Therapist (CMT), are you considered a licensed health care provider in the State of California?:       No.  California does not license massage therapy anywhere in the state unlike most states.  California regulates and certifies the practice of massage therapy through it's governing body, the California Massage Therapy Council (CAMTC).  Per California state law SB 577, I am to state therefore that I am not licensed by the state as a healing arts practitioner.  It's not a personal reflection on my training or qualifications, it is simply a fact that California does not license any healing arts practitioners. 

For more info, click on this link to SB 577:  http://www.leginfo.ca.gov/pub/01-02/bill/sen/sb_0551-0600/sb_577_bill_20020923_chaptered.html 

and subsequent final legislation SB 731: http://info.sen.ca.gov/pub/07-08/bill/sen/sb_0701-0750/sb_731_bill_20080927_chaptered.html

 

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