POLICIES AND PROCEDURES:

Welcome and thank you for choosing Brave Babies LLC for your physical therapy and wellness needs. Please carefully review and acknowledge the sections below.

Purpose and Explanation of Service

Brave Babies LLC provides motor skills screening, developmental coaching, and physical therapy services. I understand that the purpose of the program is to work with children and their families to assist each child in reaching their maximum potential to function as independently as possible and to promote active participation in home, school, and community environments.
I understand that the range of physical therapy services can include the use of hands-on or instrument assisted soft tissue techniques, corrective exercises, active release techniques, dry needling, and/or other techniques performed by a license and state certified physical therapist, based on client-specific needs or diagnosis.

Scope of Practice

Florida Law and the State of Florida Physical Therapy Board does not require patients to have a written Referral for Physical Therapy for an initial evaluation and up to 30 days of treatment by a physical therapist. However, patients are required, after 30 days, to obtain a written Referral for Physical Therapy from an licensed physician. It is your responsibility to obtain and maintain a current referral after 30 days of treatment.

Wellness and community-based services for the purposes of education, coaching, and community outreach on a continuous or consultatory basis will not be subject to restrictions of physical therapy practice.

Informed Consent for Treatment

The term “informed consent” means that the potential risks, benefits, and alternatives of therapy evaluation and treatment have been explained. The therapist provides a wide range of services and I understand that I will receive information at the initial visit concerning the evaluation findings, treatment recommendations, and options available for my child’s condition.

I understand that to evaluate the condition it may be necessary, initially and periodically, to have my therapist perform examinations utilizing manual skills, pediatric standardized testing and developmental motor scales, and observation. I am able to discuss the findings of the examination with my therapist at any time during the period that services are rendered.

Brave Babies LLC is a movement-based and hands-on Physical Therapy practice. Treatment consists of manual therapy techniques and treatment forms that are evidence-based, as well as highly specialized therapeutic exercise, neuromuscular re-education, bone and soft tissue manipulation/mobilization, myofascial release, and other treatment modalities may be used.

The number of treatments needed and recovery time can vary widely due to the client age, nature of injury, and many other contributing factors. Additionally, physical activity by its very nature carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injury. The therapist will assess and modify the environment to the best of their ability to reduce risk for injury.

Treatment interventions may result in increased levels of discomfort, however the therapist is continually monitoring the child’s response to interventions and using evidence-based tools for pain assessment with visual guides available to the parent upon request. The discomfort is a recognized potential outcome of exercise and is usually temporary. As such, if it does not subside in 1-3 days, I agree to contact my physical therapist.

I have read and fully understand the above statements. I understand the nature of the treatments at Brave Babies LLC and I authorize the fully trained staff to use treatment techniques as deemed necessary for safe and effective rehabilitation and development/habilitation. I expressly agree that this waiver and assumption of risks agreement is intended to be as broad and inclusive as permitted by the laws of the State of Florida and intended for my signature to be a complete and unconditional release of all liability to the greatest extent allowed by the law in the State of Florida.

Cooperation with Treatment

I understand that in order for therapy to be effective, the child must be present as scheduled unless there are unusual circumstances that prevent therapy attendance. I agree to cooperate with and carry out the home exercise and activities program assigned to me. If I have difficulty with any part of my treatment program, I will discuss it with my therapist.

Hybrid Model and Mode of Operations

Brave Babies LLC is dedicated to providing compassionate and quality pediatric care and early intervention services. To accommodate the volume of children awaiting services, client care is currently provided through a hybrid model. Services that require the provider to travel to the client will be available on designated days established on a quarterly basis. Patients and clients may be provided the option to travel to the provider to receive desired services on-site, currently located in Plantation, FL. The provider maintains the right to establish this option on a case-by- case basis and may revoke this option at any time.

Appointments are scheduled based on provider availability. Patients and clients have the opportunity to schedule standing appointments for the same day and approximate time as long as the schedule permits. Appointments will be scheduled on a first-come-first-served basis.

Confidentiality and Use of Information

I have been informed that the information obtained in this program will be treated as privileged and confidential and will consequently not be released or revealed to any person without my express written consent. Any other information obtained, however, will be used only by the therapist to evaluate my child’s status as needed.

Privacy Rights

Under the Health Insurance Portability and Accountability Act (HIPAA), patients have a right to privacy that includes restricting disclosure of your records and claims to your health plan, including government-based providers, for services received through a private pay option. By subscribing to the Payment Agreement below, Brave Babies LLC may assume I am exercising this right to privacy and will not disclose my medical records to any third party, including my health insurance carrier. If I want my records disclosed to any third party in the future, I will need to obtain and sign the Disclosure to Release Protected Health Information form before Brave Babies LLC will disclose my health information.

Payment Agreement

Before we begin services, please sign below indicating you have read, understand, and agree to the following payment policies:

Direct Pay and Out-of-Network Policy: Brave Babies LLC is a fee-for-service clinic. This means that Brave Babies LLC is not in-network with any private health plans. Patients/clients are free to discuss Out-Of-Network plan benefits prior to initial evaluation however reimbursement directly from the therapy provider or the insurance company for services is not guaranteed.

I agree to be financially responsible for all charges regardless of any applicable insurance or benefit payments, third-party interest, or the resolution of any legal action or lawsuits in which I may be involved.

Fees and rate of services will be established at initial evaluation or consultation and is subject to change based on treatment interventions used, revisions of services, or evolution in complexity of clinical presentation.

Payment is due at the time of service, regardless of using cash pay or using Out-of-Network Benefits. Payment is acceptable as cash, electronic payments transfer, and personal checks to payable to Brave Babies LLC.

Cancellation Policy

I acknowledge that if I must cancel a therapy/coaching session, I will give my therapist at least 12 hours of notice, and that if I cancel within the 12-hour time period of the start time of the session, I may be charged for that session. I understand that due to circumstances that may be beyond my control, I will receive one free “no show” every three months of an episode of care, meaning that I may late cancel once within a three month period and not be penalized.

All sales for consultations, infant massage/body work, motor skills screenings, developmental play coaching, therapy sessions, or intensive programs are final and nonrefundable. Developmental play coaching, educational courses, or massage sessions are valid from six months from the original purchase date and are transferable from one person to another with appropriate review of policies and procedures to be completed by the receiving party.

Acknowledgement

I acknowledge that I have read this document in its entirety or that it has been read to me if I have been unable to read the same. I consent to the rendition of all services and procedures as explained herein by all program personnel.