7#}}( HHHH R \\*xH V*V8VVVVVVVVQ: A short question for you. I have a PI patient that is not very timely with her appts. always having to cancel for one reason or another. Rarely do I see her twice a week. Her accident was April of 1998 and she had been going to a physical therapist. That has ended but they advised her to see a chiropractor because she is still having numbness in her left upper shoulder. She became my pt. about 4 weeks ago. Anyway I told her that I needed to see her a minimum of three times a week to start and she agreed...well she always has an excuse why she can't make it in for her appt. I have explained to her twice now that she needs to make her appts. or at least reschedule when she can't make it. I know I should have gotten something in writing before I accepted her but now that's too late... I feel like she might just be malingering (no real findings on any neuro or ortho tests...just her subjective pain) although she does have real neck problems on x-ray ...I wanted to know if you have any forms to cover for abandonment in case I just get tired of playing with her. I saw one that you have but, it was for pts. that don't come in to the office anymore and I thought that it probably wouldn't be right for my situation. A: Thanks for the e-mail .. first of all .. youll never be able to keep every patient. If this PI patient has an attorney .. I recommend you call this attorneys office and just tell the paralegal or receptionist that their client has been missing their scheduled appointments and they may wish to discuss this with them. Often this stimulates them to return and follow their schedule. Second .. if the patient returns .. tell them that chiropractic is a physical method of healthcare and like going to a gym repetition and momentum is best for results. Third bring to this persons attention that any physical trauma .. such as in an auto accident .. first produces paraspinal instability and future weakness unless stabilized and maintained. Therefore .. they should follow the schedule as close as possible and if appointments are missed they should be made up as soon as possible during the initial phase of their care. If the patient has no attorney and is using their health or auto insurance .. or just pays cash .. the ultimate decision for their care is theirs .. all you can do is recommend what you feel they need. I agree .. if the patient has not been in for awhile it is important to document your attempt to advise them to return or seek care elsewhere. As far as malingering you dont have to worry or concern yourself about it. Your job is to get the patient back to a near normal condition prior to her injury .. if you feel she can be released .. release her .. if not take care of her until she is ready. Also .. if she wishes to come as she wants (supportive or maintenance care) she should be aware of it and tell her that since payment is dependent upon her settlement .. you will send a claims to her attorney or the insurance company involved advising them that she is being released from active care and advise to return as needed. Let her know this .. in my book there is a What Now for .. I think in Chapter 3 .. use it to release her. Below is one of the letters I send when they havent been in for awhile. Date: Patient: Date of Last Adjustment: You have missed a number of your scheduled appointments and we have unsuccessfully attempted to reach you by phone. As you are aware, my purpose was and still is to provide you with conservative care for injuries sustained in your auto related collision. If you wish to discontinue this care, or have any concerns that I should be made aware of, please do not hesitate to call me. If you wish to discontinue care, we need to complete your records with a final examination. If, for whatever reason, you do not wish to return for a final examination, please call it to our attention. If we do not hear from you within two weeks of the above date, we may contact your insurance provider and/or attorney, if represented by one, with a final status and claim. Please call to schedule your appointment if you wish to return for care. If you wish a referral to another chiropractor closer to home or work, or wish a referral to a medical specialist, I would be more than happy to assist you. If there are any questions, please do not hesitate to call. Yours in Health, Joel E. Margolies D. C. If you intend to not return for further care or a final examination, please complete these questions and return this letter to our attention within the enclosed envelope: I do not wish to continue care due to: p I feel I am completely better p I am too busy and havent the time p I wish a referral to another health care provider Note any problems that still remain from your injuries: _______________ ________________ _______________ ______________ ________________ ________________ _______________ ______________ cc: Patient File uVTEXTMSIEFavorites Temp.htmlAmerica Online$$eÄVVexVTEXTMSIE`Favorites Temp.htmlAmerica Online$eՄV/VexV0TEXTMSIEDo:@Bkmij{} @   Cd>f? yz;<)*+DEfk!"ij{|}ԞȞ𞋞! !! !  !AA A!A! ! ! ! ! ! @ }} }+ }   *X*****:? HH@R(,, `,-^&'=/B@H-:DW Series 6.0.4  Zapf DingbatsTimes} EEC