cdebbie$ontenot .~,,"?;j~:uyj~&;~:~"''''' ~ cj>hysical 'Therapy ~ Wellness 134Jomela Street. cfj.o.cbox J:g.fayette,.

Similar documents
Informed Consent for Chiropractic Care

HOUSE BILL NO. HB0296. Representative(s) Zwonitzer, Dv. and Meyer and Senator(s) Johnson A BILL. for

Personal Care Attendant

A GUIDE TO HOSPICE SERVICES

Personal Emergency Response System

HMSA Physical and Occupational Therapy Utilization Management Authorization Guide

LOUISIANA ADVANCE DIRECTIVES

School Based Oral Health Services

EPSDT Health Services

OUTLINE OF MEDICARE SUPPLEMENT COVERAGE

AMERICAN BOARD OF CRANIOFACIAL PAIN

APEx ACCREDITATION PROCEDURES. April 2017 TARGETING CANCER CARE. ASTRO APEx ACCREDITATION PROCEDURES

Mental Health. Notice of Privacy Practices

Chiropractic Record Keeping

LOUISIANA ADVANCE DIRECTIVES

This chapter shall be known and may be cited as the "Alabama Athletic Trainers Licensure Act."

McHenry Western Lake County EMS System Optional CE for EMT-B, Paramedics and PHRN s Documentation and Release Forms Optional #8 2018

Main Study Informed Consent Form, Version D (Direct)

Associates in ear, nose, throat/ Head & Neck surgery, pllc

ALASKA ADVANCE HEALTH CARE DIRECTIVE for Client

LOUISIANA REVISED STATUTE 37: THE LOUISIANA RADIOLOGIC TECHNOLOGIST LICENSING LAW

PATIENT BILL OF RIGHTS & NOTICE OF PRIVACY PRACTICES

APPROVED REGULATION OF THE BOARD OF OCCUPATIONAL THERAPY. LCB File No. R Effective May 16, 2018

79th OREGON LEGISLATIVE ASSEMBLY Regular Session. Enrolled. Senate Bill 58

Hesch Institute Jerry Hesch, MHS, PT, DPT(s)

INFORMED CONSENT FOR TREATMENT

FILED. BEFORE THE KANSAS STATE BOARD OF NURSING JUL 14?OO8 Landon t'"'"r:lt:?:,liitij 33nw Jackson #1051 KSBN

ALABAMA~STATUTE. Code of Alabama et seq. DATE Enacted Alabama Board of Medical Examiners

Prevention of Sexual Abuse of Patients. Introductory Instructor s Guide for Educational Programs in Medical Radiation Technology

NC General Statutes - Chapter 90 Article 36 1

Under the Magnifying Glass

Title 32: PROFESSIONS AND OCCUPATIONS

Body Basics Physical Therapy Medical History

STATE OF FLORIDA BOARD OF CLINICAL SOCIAL WORK, MARRIAGE AND FAMILY THERAPY AND MENTAL HEALTH COUNSELING

Kim E. Stiegler, D.M.D.

APPLICATION FOR REINSTATEMENT OF AN EDUCATOR S LICENSE (PRINT OR TYPE ALL INFORMATION)

NOTICE OF PRIVACY PRACTICES UNIVERSITY OF CALIFORNIA IRVINE HEALTHSYSTEM

THE COUNSELING PLACE ADULT INTAKE FORM Yearly Family Income:

Title 18 RCW Chapter

LEGISLATIVE RESEARCH COMMISSION PDF VERSION

FILED. Now on rhrs Z-L;"ror :V $EP KSBN

PETITION FOR DISSOLUTION OF SUMMARY SUSPENSION. , hereinafter referred to as Respondent, by and

DURABLE POWER OF ATTORNEY FOR HEALTH CARE

A final version of the correction order form is enclosed. This document will be posted on the MDH website.

Basic Guidelines for Using the Advance Health Care Directive Form

NEW BRIGHTON CARE CENTER

PATIENT ADVOCATE DESIGNATION FOR MENTAL HEALTH TREATMENT NOTICE TO PATIENT

The World of Evaluation and Management Services and Supporting Documentation

DURABLE POWER OF ATTORNEY FOR HEALTH CARE

Person to Contact in Case of Emergency. THE COUNSELING PLACE YOUTH INTAKE FORM Yearly Family Income:

Northern Ireland Social Care Council. NISCC (Registration) Rules 2017

STATE OF FLORIDA BOARD OF CLINICAL SOCIAL WORK, MARRIAGE AND FAMILY THERAPY AND MENTAL HEALTH COUNSELING

City. Whom may we thank for referring you to us?

5 th Street Chiropractic

MASSACHUSETTS ADVANCE DIRECTIVES

DEPARTM PRACTICES. Effective: Tel: Fax: to protecting. Alice Gleghorn, Page 1

Opp Health and Rehabilitation, LLC 115 Paulk Avenue P.O. Box 730 Opp, AL Phone Number: (334)

ENROLLMENT PACKET FOR THE LOUISIANA MEDICAL ASSISTANCE PROGRAM (Louisiana Medicaid Program) Early Steps (Group)

HIV CONSUMER RIGHTS. Rights in Accessing Service Delivery System

MSK Group, PC NOTICE O F PRIVACY PRACTICES Effective Date: December 30, 2015

Macon County Mental Health Court. Participant Handbook & Participation Agreement

Table of Contents. Introduction: Basis, purpose and statutory provision

Welcome to Pinnacle Chiropractic Spine and Sports Center

HMSA Physical & Occupational Therapy Utilization Management Guide Published 10/17/2012

GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2017 H 1 HOUSE BILL 902. Short Title: Enhance Patient Safety in Radiologic Imaging.

Welcome to Pinnacle Chiropractic Spine and Sports Center

PREOPERATIVE PATIENT QUESTIONAIRE

NOTICE OF PRIVACY PRACTICES FOR MAYO CLINIC ARIZONA

Session of HOUSE BILL No By Committee on Health and Human Services 1-23

NASI Per Diem Malpractice

STATE OF FLORIDA DEPARTMENT OF HEALTH

PHYSIOTHERAPY ACT STANDARDS AND DISCIPLINE REGULATIONS

DURABLE POWER OF ATTORNEY

Notice of Privacy Practices for Protected Health Information (PHI)

Outpatient Wellness Clinic

RULE DELEGATION AND SUPERVISION OF MEDICAL SERVICES TO UNLICENSED HEALTH CARE PROVIDERS PURSUANT TO SECTION (3)(l), C.R.S.

-Sacramento City College Physical Therapist Assistant Program- PTA 122: Introduction to Clinical Practice Evaluation of Student

Federally Qualified Health Center

2015 Florida Laws and Rules

Welcome to Dentistry by Design!

NOTICE OF PRIVACY PRACTICES

PATIENT INFORMATION & CONDITION FORM

DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS DIRECTOR'S OFFICE CHIROPRACTIC - GENERAL RULES

OUTLINE OF MEDICARE SELECT SUPPLEMENT COVERAGE

State of California Health and Human Services Agency Department of Health Care Services

POLICIES OF THE ASSESSMENT CENTER AT OAK HILL ACADEMY

BON RULE CHANGES. Rule 213. Practice & Procedure Corrective Action Deferred Action K-STAR (New Rule)

*Family Chiropractic Care* New Patient Information Worksheet*

HUNTINGTON S DISEASE SOCIETY OF AMERICA CENTERS OF EXCELLENCE 2018 Program Description

PATIENT RIGHTS TO ACCESS PERSONAL MEDICAL RECORDS California Health & Safety Code Section

STATE OF FLORIDA DEPARTMENT OF HEALTH

NC General Statutes - Chapter 90 Article 18D 1

Record Keeping - Legal and Ethical Core CPD

2201 Murphy Avenue, Suite 307 Nashville, TN Phone Fax Date. Patient s Full Name

STATE OF FLORIDA DEPARTMENT OF HEALTH

Advance Health Care Directive (California Probate Code section 4701)

MARYLAND ADVANCE DIRECTIVE: PLANNING FOR FUTURE HEALTH CARE DECISIONS

Protecting, Maintaining and Improving the Health of Minnesotans

SUMMARY OF JOINT NOTICE OF PRIVACY PRACTICES (HOSPITAL AND MEMBERS OF ITS MEDICAL STAFF)

DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS DIRECTOR'S OFFICE CHIROPRACTIC - GENERAL RULES

Transcription:

cdebbie$ontenot.~,,"?;j~:uyj~&;~:~"''''' ~ cj>hysical 'Therapy ~ Wellness 134Jomela Street. cfj.o.cbox 52424 J:g.fayette,.t:guisiana 70503 March 7, 2007 Mr. Glenn R. Ducote 2148 Government St. Baton Rouge, LA 70806 Re: Consent Order/Case Number 20061 Dear Mr. Ducote: The complete records on the Mrs. Carmer Falgout are enclosed. I am also sending you a copy of the cost which I sent to Cheryl Gaudin. I do not have an address for Mark Brown. Ms. Gaudin and I are searching for the documentation course. I want to be completely compliant in this matter. Thank you for.your help. cc: Mark Brown Cheryl Gaudin cfjhone:(337) 233-3333 $ax; (337)232-3559 www.la-physicaltherapy.com.debifont@la-phusicaltherapu.com

In the Matter of DEBBIE FONTENOT, P.T. License No. 0192 Respondent * * LOUISIANA STATE BOARD OF * PHYSICAL THERAPY EXAMINERS * Case Number 20061t.l4 CONSENT ORDER A complaint was initiated with the Louisiana State Board of Physical Therapy Examiners (Board) in June, 2006, by a patient who had received treatment by Debbie Fontenot, P.T., (Respodent) at the out~patient clinic which Respondent owns and operates in Lafayette. The patient reported that she was billed for treatments not received and that when she called to inquire about the error she was rudely treated. Patient also questioned the appropriateness and efficacyof the treatment provided by Respondent. Ms. Fontenot 'was notified of the complaint and an informal conference was held at the Board office on October 25, 2006 with investigating Board member Mark Brown, Executive Director Cheryl Gaudin and Board attorney Glenn Ducote participating with Ms. Fontenot. In response to Board requests, Respondent provided billing records for services charged to the patient as her patient treatment record. She indicated that no other documentation existed or was necessary. FINDINGS OF FACT 1. Respondent Debbie Fontenot treated complainant for TMJ on March 2, 3 and 6, 2006. 2. Respondent's treatment records for complainant consisted of a narrative evaluation report and an itemized billing record, containing only the date, code, identification of modality and amount charged for each modality. 3. Respondent and complainant are in conflict with regard to whether whirlpool treatment was received by patient. Respondent has removed charges for those services from patient's billing. CONCLUSIONS OF LAW Respondent's conduct described above and otherwise reviewed in this action is subject to and/or in violation of the followingprovisionsof law regarding his practice of physical therapy: 1. The Board has the authority to suspend or revoke a license which it has issued or place probationary conditions upon such license upon proof that the licensee has been guilty of unprofessionalconduct. La. R. S. 37:2413A(7) and Board Rule 325. 2. Respondent's documentation of her patient's treatment did not conform with the requirements of Board Rules 323A and A(5)..

DECISION Pursuant to the foregoingfindings of Fact and Conclusions of Law, and in order to avoid further administrative and judicial proceedings, Respondent and the Board, by vote of quorum, agree as follows:," A. Respondent agrees to welcome Board representatives making unannounced random monitoring visits to her clinic and to provide ready and convenient access to patient treatment records for examination to determine compliance with BQard documentation requirements. Respondent. shall reimburse the Board in the amount $100 for each monitoring visit to her practice. Such monitoring visits will end one year after the effective date of this Consent Order unless the BO;:trdfinds that documentation standards are still not being met, in which case the monitoring period may be extended until a record of compliance has been established. B. Respondent shall complete a continuing education course in treatment documentation, which course shall be approved in advance by the Executive Director. This CE course shall be completed within one year from the effective date of this Consent Order and shell be in addition to the continuing education requirements already established for license renewal. C. Respondent declares that, before signing this Consent Order, she has carefully read this document and freelyconsents to it as valid and binding upon her. She is aware of her right to a notice of hearing, to a formal administrative hearing and to judicial review of an administrative finding, and she freelywaives those rights. She is aware of her right to be represented by counsel in these proceedings and she freelywaives that right also. D. Respondent acknowledgesthat her failure to comply with any term of this Consent Order is a basis for further disciplinary action by the Board and that the presentation to and consideration of this Consent Agreement by the Board, including presented documentary evidence and information, shall not unfairly or illegallyprejudice or preclude the Board, or any of its members, from further participation in hearings or other resolution of these proceedings. E. Respondent acknowledgesthat this Consent Order becomes effective only upon signature by the Board Chair. SWORN TO AND SUBSCRIBEDon this Ldayof ~2007. AGREED AND ACCEPTED by official action of the Board, the 26th day of October, 2006, at Lafayette,Louisiana. LOUISIANA STATE BOARD OF PHYSICALTHERAPYEXAMINERS

cdebbie$ontenot <Physical 'Therapy ~ Wellness 134JomelaStreet. rp.o. rfjox52424 J:gfayette, fguisiana 70503 March 2,2006 Patient: Carmer Falgout Chart Number: 10137 Diagnosis: TMJ Dysfunction;Right Onset: February 6, 2006 History: This 66 year old lady recalled the onset of her condition having been February 6 at which time symptoms began without provocation. She though she was experiencing severe tooth pain. After consulting with her dentist, Dr. Darah Fugetta physical therapy was recommended. She had a fall January 18 injuringher tailbone and fracturing her right wrist. She arrived here today with her referral stating that she is without medications. Evaluation: Mrs. Falgout arrived here today in subacute distress explaining the nature of her chief complaints. She is experiencing 5/10 pain over the right side of her face. Initiallyshe thought she was experiencing root decay of one of her upper teeth. This was ruled out. She stated that part of a tooth was very slightly"fileddown" on the left. Symptoms persist. Upon palpation increased tenderness are felt withinthe right Temporomandibular joint, orally over the right internal pterygoid withinthe anterior tonsillar pillars and the right mastoid process behind her ear, base of her skull. There is palpable asymmetry of movement in the jaw joints as she opens and closes her mouth without crepitation. Jaw movements are not limitedthough movement is slightlydeviated to her right. The patient is left handed, slightlyrotates her head towards the right focusing with her left eye. These symptoms do not cause her to experience headaches. At this time she is without cervical spine symptoms. Active rotation and lateral flexionwere well performed without limitationsof motion. Terminal hyper extension caused some right sided discomfort. Fullhead flexionwas performed with a listto her right side. Spurling's sign is negative for cervical nerve root impingement. Distraction is negative for facet tightness. Strength in arms is good, equal and symmetrical. Recommendation: 1. That this patient is given a conservative physical therapy protocol for reductionoftmjsymptomology.. 2. That this patient's center of gravitational pull in the head/necklbacklpelvis is adjusted slightlyto its near anatomical placements as indicated. 3. That this patient is taught jaw stretching exercises for home protocol. Thank you Dr. Fugetta for allowingme to see and treat your patient. rphone:(337) 233-3883 $ax: (887)232-3559 www.la-physicaltherapy.com.debifont@la-physicaltherapy.com

rdebbie$ontenot Physical 'Therapy ~ WeUness.184Jomela Street.rf.O. rjfox 52424 J:gfayette,.tguisiana 70508 3M] Patient: Carmer Falgout Chart Number: 10137 Date: March 2, 2006 The patient received hydrotherapy, TENSto TMJjoint followed by light ultra sound, light spray/stretches, soft tissue mobilizationand active exercises to the jaw/sublingual muscles. After one and a half hour of PT she left in relaxed with lessdiscomfort. Date: March3, 2006. The patient received hydrotherapy, TENSto TMJjoint followed by light ultra sound, light spray/stretches, soft tissue mobilizationand active exercises to the jaw/sublingual muscles. After one and a half hour of PT she left in relaxed with less discomfort. Date: March 6, 2006 The patient received hydrotherapy, TENSto TMJjoint followed by light ultra sound, light spray/stretches, soft tissue mobilizationand active exercises to the jaw/sublingual muscles. After one and a half hour of PT she left in relaxed with less discomfort. ~ rfhone:(887) 288-8333 $ax: (337)232-3559

C/)ebbie$ontenot <Physical'Therapy ~ Wellness 134Jomela &reet. IJ'.O.tJJox52424. gfayette, J:guisiana 70503 March 17, 2006 Dr. Darah Fugetta 229 Bender Road Lafayette, La 70503 Re: Carmer Falgout Dear Dr. Fugetta: Ms. Falgout received physical therapy on three separate occasions. Adjustments were made, home exercises were instructed and she tolerated the physical therapy protocol satisfactorily. At this time she will be discharged from my care. She was encouraged to telephone my office if she had any further questions. I would like to thank you Dr. Fugetta for allowing me to see and treat your patient. Respectfully,. IJ'honed 337) 233-3333.!Pax: (337) 232-3559 www.la-physicaltherapy.com.debifont@la-physicaltherapy.com

, r;debbie$ontenoṯ rj'hysical 'lherapy ~ Wellness 134Jomela Street.!/J.O.lfJox 52424 J:g,fayette,J:guisiana70503 May 31, 2006 Ms. Carmer Falgout 110 Charles Read Ave. Lafayette, La. 70503 Dear Ms. Falgout: As per our telephone conversation the adjustments will be made. I do remember you getting into the whirlpool but you do not. In reference to my billing clerk billing Medicare, the first day you arrived at my office you gave us billing information with a Medicare card and supplemental insurance with USAA Life. It's understandable that you wished we billed these. I do accept assignment but if you would like to pay us in full that would be fine here. With all due respect you were initially treated here March 2 and it's almost three months later. According to my records your referring dentist does not have a UPIN number and this might present a problem. I will discuss this with Ms. Heather, billing clerk. Enclosed you will find a copy of my evaluation dated March 2, 2006. It is standard office procedure to evaluate all patients prior to beginning physical therapy. If your treatments here would have continued, a re evaluation of your condition would have been performed prior to a discharge note. If you have any further questions please speak to me directly. I am the only physical therapist at this facility. I do regret my expressed displeasure on the telephone today, the accusations'you made against me and my clinic's billing department are intolerable. Medicare pays a very small portion of the bills sent out electronically, preferably if I did not accept assignment you would be responsible for the costs, then you would had to have filed with your insurance companies on your own. I do sincerely hope this satisfies your questions. Respectfu liy, Debbie Fontenot, PT CPhone:(337) 233-3333.!Pax:(337) 232-3559 www.la-physicaltherapy.com.debifont@la-physico1therapy.com