By Dr. David Edward Marcinko; MBA

Although following a bell-shaped standard distribution curve does not protect you from having your surgical consent-forms audited; it can go a long way in establishing your usual-customary-reasonable standard-of-care protocol to a third-party reviewer, quality assurance manager, insurance company, patient attorney, etc.

Consent-Forms Vary

Understanding your options is the first step in visualizing and upgrading the bell-curve. For example, in modern podiatric practice, there are usually several different practice venues. Accordingly, podiatrists encounter patients in at least six different venues that require consent-form use.

More importantly, most of the consent-forms are markedly different at each institution or venue, and some podiatrists don’t recognize the problems that this may cause. So, here is a typical location line-up for the average modern podiatrist:

1.       Multi-specialty group

2.       Clinic

3.       Podiatry office

4.       ASC

5.       Hospital [out-patient]

6.       Hospital [in-patient]

Even more vexing is the fact that most podiatrists use a dizzying combination of the above locations in their professional lives.

Documentation   

It is well known that true patient informed-consent is a collaborative communication process between patient and surgeon. And, it is bi-lateral collaboration; not just the completion of a mere medico-legal form.

Nevertheless, the process is recorded for legal posterity on the consent-form.

Therefore, medical risk-managers, attorneys and insurance agents increasingly believe that consent-forms should have the same “look and feel”, “format and style”, “inclusions and recitations” for each patient; regardless of venue.

In other words, “why should a consent form differ – for the same procedure – when done at different locations? Ceteras paribus.

Self-Evaluation and Need for Consent-Form Improvement

Today, podiatrist’s can review physical charts or electronic medical records [eMRs] to evaluate where their consent-form use falls within the above schematic. And, most podiatrists have noted significant location changes as modern practice continually evolves.

The Bell Shaped Curve

A normal bell-shaped-curve for most podiatrists would probably demonstrate most of the procedural venues spread out fairly evenly over the different locations above; with a smaller number at the top and bottom levels. The majority would be in the third-fourth levels; podiatry office and Ambulatory Surgery Center.

Assessment

e-Podiatry Consent Forms ™ may be used to standardize your documentation and informed-consent process, regardless of venue, by using professionally prepared Agency for Healthcare Research and Quality [AHRQ] styled forms.

Conclusion

· Using standardized e-Podiatry Consent Forms™, across the entire spectrum of venues, may be a prudent malpractice defense step.

· Using e-Podiatry Consent Forms™ establishes a consistent standard-of-care level for the informed-consent process and related documentation.

· Using e-Podiatry Consent Forms™ may improve patient care quality.

· Using e-Podiatry Consent Forms™ may reduce your professional liability risks.

You, your patients and the profession deserve nothing less than e-Podiatry Consent Forms™.  

TO ORDER: http://epodiatryconsentforms.com/order-form/

Ellen Mann sued her podiatrist, alleging that the defendant doctor failed to render proper post-operative care, that the defendant did not obtain informed consent to the surgery, and that his failures constituted medical malpractice.

Patient Mann acknowledged that she signed a form that established her consent to the surgery, but she claimed that the defendant did not disclose that the procedure could have caused a permanent deformity.

Thus, Mann’s counsel contended that the defendant did not obtain Mann’s informed consent.

Her lawyer also contended that the defendant wrongly disregarded his original belief that the pin could not be removed until four weeks had passed.

Read more and vote: lack-of-informed-consent 

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; FACFAS, MBA – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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About Informed Consent

Many podiatrists feel that informed consent is merely a formality necessary to obtain the patient’s signature on a form in order to allow a specific procedure or treatment to be performed on the patient.

Rather, informed consent should be thought of as a communication process through which a patient, with the advice and support of his or her physician, makes decisions concerning the treatment he or she will receive. The process assists in developing the critical element of trust between the podiatrist and patient, and is often the most important discussion a physician will have with his or her patient.
Patients may bring a claim or lawsuit against the hospital and/or a podiatrist predicated solely on the allegation that they did not give their consent; this is called a battery.

A second more common claim is that the consent given was not based upon proper and adequate information; this is known as a claim for “lack of informed consent.” This type of claim is usually found as part of the typical malpractice or negligence action. Because of this type of potential claim, from a risk management perspective, the informed consent process plays a crucial role in minimizing the exposure of both the hospital and podiatrist to medical malpractice claims and lawsuits.

What Is Informed Consent?

Informed consent is a three part process in which there is an exchange of information between the physician and patient.

The first part is the disclosure and explanation to the patient, in language that the patient can understand, of the nature of a proposed procedure or treatment, its potential risks and benefits, and reasonable alternatives which may be available.

The second part of the process involves: 1) ensuring that the patient understands what has been explained to him or her (to the best of the patient’s intellectual capacity); 2) the patient accepting the risks; and 3) the patient giving his or her consent to undergo the procedure or treatment; and finally, 4) the process must be documented.
In the sequence noted above, in many instances, the patient will be asked to sign a form acknowledging that he or she has received sufficient information upon which informed consent can be given for the procedure or treatment, and has given his or her voluntary permission to undergo it. Also, the podiatrist who had the discussion with the patient must document the details of the discussion in the patient’s medical record.
Physicians and podiatrists are responsible for obtaining informed consent. The podiatrist who will perform the proposed procedure or treatment should engage in this process with the patient. It is acceptable for a doctor to delegate the task of obtaining the patient’s signature on the necessary consent form to another member of the health care team. However, this should occur only after the discussions necessary for a patient to give his or her informed consent have occurred.

What Information is Discussed During the Informed Consent Process?

Where possible, it is desirable for the informed consent discussion to occur a sufficient period of time before the proposed procedure or treatment in order to allow the patient time to consider the information and ask questions. During the discussion, it is recommended that the podiatrist use language the patient can understand and avoid the use of “medical jargon.” The informed consent discussion may take place in the doctor’s office prior the patient’s hospital admission, in the patient’s hospital room, and in emergent situations, in the emergency room or other procedure/treatment areas of a hospital.
A patient must have capacity in order to give informed consent. This requires that the patient understand the proposed procedure or treatment and be able to voluntarily give or withhold his or her consent after making an informed decision. Informed consent may be given by adult patients with capacity, the parent or legal guardian of a minor, emancipated minors under specific circumstances or a court or patient designated surrogate of a patient without capacity. In some instances, a family surrogate may give consent.
The following information should be discussed with the patient and documented in the medical record:

• The nature of the patient’s illness, the diagnosis, the proposed treatment plan and the prognosis.
• A description of the recommended procedure or treatment, and its purpose.
• The probable outcome particularly if it is difficult to predict, and the patient’s expected post-procedure/treatment course.
• The most likely risks and side-effects, the potential benefits, as well as the potential complications of the procedure or treatment.
• Reasonable alternative methods of treatment or non-treatment including the risks, benefits, complications, and prognosis associated with each alternative or with non-treatment.

As a general rule, a doctor is required to disclose information to a patient that a reasonably prudent person under similar circumstances would want to know. A podiatrist need not disclose all of the risks or complications which may occur, but should discuss: 1) those commonly associated with the procedure or treatment and having a reasonable chance of occurring; and 2) those which have a small chance of occurring, but which have grave consequences. Less common or remote risks/complications should be discussed with the patient if they are significant to that patient.

How Should the Informed Consent Process Be Documented In The Medical Record?

The informed consent process is documented in two separate ways in the medical record.

The first way is by obtaining the patient’s signature on an appropriate consent form following the necessary disclosure of information upon which a patient can give his or her informed consent. The second way is by documenting the informed consent process in the patient’s medical record. This can be an entry in the office records maintained by a doctor or by a progress note in the hospital record.

The Consent Form

Many state laws and hospital policies and procedures require that written informed consent must be given by all patients before any non-emergency operation, invasive procedure or treatment, regardless of whether that procedure takes place in the operating room, a treatment room or office. Yet, all are different. These must be signed by all patients and the responsible podiatrist. When questions arise regarding the need for consent forms, a health law attorney should be consulted; along with state specific podiatry practice acts.

Entries in the Medical Record

The contemporaneous documentation of the informed consent process serves as the foundation for the defense of any subsequent claim by a patient for lack of informed consent. The signature of the patient on a consent form alone is not legally determinative evidence that the patient has given informed consent. Poor or absent documentation will force a doctor to testify from recollection about an event which occurred several years previously, which will undermine his or her credibility. In addition, poor or absent documentation may be a significant factor in a patient’s attorney’s decision to institute a legal action.
To reiterate, the podiatrist who had the discussion with the patient must document the details of the discussion in the patient’s medical record. The entry in the medical record regarding the informed consent process should describe the information disclosed to the patient. Avoid the use of summary statements such as “The patient was advised of the potential risks/complications of the operation and alternatives” and instead, note at least some of the actual risks, complications and alternatives discussed with the patient.

For example, the entry could state that “information regarding the risks, complications and alternatives were discussed with the patient and/or family, including but not limited to …. etc”, followed by the specific information discussed.

Finally, note whether the patient was given any written informative material, such as e-Podiatry Consent Forms™ regarding the procedure or treatment. It is also important to document any questions asked by the patient and the answers given.

Document Production Service

e-Podiatry Consent Forms™ is a document production service for physicians only. Our forms are not health advice, nor are they a diagnostic or surgical care treatment plan. Forms are administrative paperwork and not the standard of medical care, in any way. Patients should always seek the advice of a qualified physician. Doctors should seek legal advice from their medical malpractice insurance carriers and/or a qualified health law attorney prior to modification, template completion and use.

References and Sources:

•  Healthcare Organizations [Journal of Financial Management Strategies] www.HealthcareFinancials.com
• Insurance and Risk Management Strategies for Physicians and Advisors http://www.jbpub.com/catalog/9780763733421/
• Yale Risk Management Handbook; and the Yale-New Haven Hospital & Yale University School of Medicine www.med.yale.edu/caim/risk/handbook/rmh_contents.html

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Next-Gen Podiatrists Opting-Out?

By Dr. David Edward Marcinko; FACFAS, MBA

Of course, it’s getting more expensive these days to take hospital call as physicians and podiatrists are electing not to take this responsibility because of decreased reimbursement rates. Others opt-out because of a desire to spend more time with family, and/or scheduling conflicts. And, let’s not forget the liability concerns.

Historical Review

But, back in the day, I recall eagerly signing up for call to make a few extra bucks [it was a very competitive proposition back then], as I started my fledgling practice.  About a decade later, I didn’t make much on-call money any more, but continued my rotation and chalked it all up to societal “pro-bona care”. It was good for the residency program, as well. And, the increased service visibility still garnered me a few lucrative patient referrals.

Then, it became a financial mess and out-of-office time-loss, and ultimately a great liability and headache. Fortunately, I could afford not to do it any more; and quit. Let the younger guys and gals “pay their dues”, I reasoned.

Legal Issues

Today, there is a growing revolt of specialists against hospital on-call duties that threatens to violate Federal law and lose status as trauma centers. And, specialties other than podiatry most likely to refuse call include plastic surgery, ENT, psychiatry, neuro-surgery, ophthalmology and orthopedics.

Of course, refusing to respond to assigned call may be a violation of Federal law and carries fines as much as $50,000 per case.

Opting–Out

In contrast, refusing to sign up for call does not violate the law, and some physicians and podiatrists are taking this option. The opting-out problem is especially acute in California where hospitals are combating the issues with compensation, reporting miscreant doctors to the authorities, or threatening to remove them from staff completely.

This is hardly a good situation for podiatrists who may have only recently won the right to ER call coverage in some areas.

Assessment

Nevertheless, some doctors are fighting back with lawsuits.

Other Supporting Opinions

Essayist Jeff Goldsmith, President of Health Futures Inc, and Associate Professor of Public Health Sciences at the University of Virginia* recently opined that:

“We can expect intensified conflict with private physicians over the hospital’s 24-hour mission and service obligation, specifically providing physician coverage after hours and on weekends. Younger physicians have shown decreased willingness to trade their personal time to cover hospital call in exchange for hospital admitting privileges as their elders did. Those admitting privileges are either less essential or completely unnecessary in an increasingly ambulatory practice environment. The present solution is for hospitals to pay stipends to independent practitioners for call coverage or to contract with single specialty groups large enough to rotate call internally.”

Conclusion:

And so, as a podiatrist, what are your thoughts on this highly emotional, and increasingly contentious, topic? Is it related to a type of “informed-consent” for the attending podiatrist?

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko MBA is available for medical seminars or other speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

Copyright 2008 iMBA Inc: All rights reserved, USA. Use is restricted to www.ePodiatryConsentForms.com subscribers and visitors only. No redistribution is allowed. To avoid violation of iMBA Inc copyright policy, please register for your own free membership.

Related Information Sources:

Board Certification Preparation: www.PodiatryPrep.com

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Referrals: Thank you in advance for your electronic referrals to www.ePodiatryConsentForms.com

An Emerging Competitive Peril

By Dr. David Edward Marcinko; FACFAS, MBA

In the past, a podiatric medical expert witness for the plaintiff was merely an opposing opinion by a learned colleague. Today, it is becoming a risk management minefield as the AMA/APMA/AOA and other groups are urging state medical licensing boards to police expert witnesses, which might require expert testimony be considered the practice of podiatric medicine.

The AANS

This seems especially true with the Rolling Meadows Illinois based American Association of Neurological Surgeons (AANS).

Feuding Members

Currently, a member of the AANS can file a complaint against any fellow member for testimony as either an expert witness for the plaintiff, or defense witness for the doctor. A committee of four then reviews the court records and requires the accuser to face the accused in a formal review. Sanctions range form three months to a year, to complete expulsion from the association. In the past twenty years, the program has reviewed 27 cases all involving plaintiff testimony. One led to expulsion and ten to suspension.

Assessment

Since 2001, the courts are beginning to take the AANS process seriously. After years of operations without strong legal backing, the program was upheld by the 7^th Circuit Court of Appeals, in Chicago by a neurosurgeon whom the group suspended in 1997. So always remember, if you testify falsely against a fellow podiatrist, or too far from the norm, you may be at risk.

Conclusion:

As a podiatrist, what conclusion might an opposing expert witness draw from a review of your consent-form documents; and/or informed consent process?

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko MBA is available for medical seminars or other speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

Copyright 2008 iMBA Inc: All rights reserved, USA. Use is restricted to www.ePodiatryConsentForms.com subscribers and visitors only. No redistribution is allowed. To avoid violation of iMBA Inc copyright policy, please register for your own free membership.

Related Information Sources:

Board Preparation: www.PodiatryPrep.com

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Referrals: Thank you in advance for your electronic referrals to www.ePodiatryConsentForms.com

Some Liability Considerations for Podiatrists

Dr. David Edward Marcinko; FACFAS, MBA

As a podiatrist, you are no doubt suffering under spiraling premium payments for malpractice insurance. So, always take the time to review your policy often and consider the following evolving issues.

New Considerations for 2009 … and Beyond

Perhaps your podiatry practice has specialized as your reputation has grown. Has your insurance agent/company designed a policy around the needs of your office?  Do not pay for coverage you would not use, and certainly do not leave gaps in your coverage so as to bear the risk of losses yourself.  A series of riders and endorsements from an insurance company will create a more specialized policy that addresses your insurance needs. 

Staying within Policy Scope

With respect to the scope of podiatric malpractice coverage, many liability insurance policies will deny coverage if an intentional tort is alleged. One example of an intentional tort is intentional infliction of emotional distress, which doctors may need to defend against if they misdiagnose a patient while having a financial interest in the treatment of the diagnosis.  

Battery is another intentional tort with which podiatrists may be charged if practicing beyond license scope is alleged; as in a leg surgery case a few years ago in Boise, Idaho.  Battery can be defined as any injurious contact without consent. The necessity of obtaining informed-consent from each patient is becoming increasingly important as a defense against such claims.

Intentional torts are to be distinguished from torts of negligence, which are usually covered under most liability insurance policies.  Negligence claims arise out of mistakes usually attributable to carelessness. 

Make sure your insurance policy extends to intentional torts to prevent these kinds of cases from being denied coverage by your insurance company.

Policy Limit Considerations

In addition, carefully consider the policy limits of your insurance and do not blankly accept the customary limits proposed by the insurance company. Instead, research the minimum amounts of coverage required in the location in which you practice, and adjust that upward to reflect the factors that cause malpractice judgments to increase.

Such factors include the clientele that you serve, the speed with which you must make medical decisions, the hospitals and surgical centers with which you are affiliated, and the relative cost of repairing damage made by an erroneous decision.

Conclusion: 

And so, have you ever been sued for a cause other than strict medical negligence; an intentional tort arising from an alleged lack of informed consent, for example? 

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko MBA is available for medical seminars or other speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

Copyright 2008 iMBA Inc: All rights reserved, USA. Use is restricted to www.ePodiatryConsentForms.com subscribers and visitors only. No redistribution is allowed. To avoid violation of iMBA Inc copyright policy, please register for your own free membership.

Related Information Sources:

Board Preparation: www.PodiatryPrep.com

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Referrals: Thank you in advance for your electronic referrals to www.ePodiatryConsentForms.com

The New Nosocomial Conditions

Dr. David Edward Marcinko; FACFAS, MBA

Did you know that “never-events” are also being called “hospital acquired conditions”; in some cases? 

Terms and Definitions 

Below is the list of conditions that the Centers for Medicare and Medicaid Services (CMS) selected in its FY 2008 final rule: 

• Serious Preventable Event — Object Left in Surgery
• Serious Preventable Event — Air Embolism
• Serious Preventable Event — Blood Incompatibility
• Catherther-associated Urinary Tract Infections
• Pressure Ulcers (Decubitus Foot Ulcers)
• Vascular Catheter-Associated Infection
• Surgical Site Infection — Mediastinitis after Coronary Artery Bypass Graft (CABG) Surgery
• Hospital-Acquired Injuries — Fractures, Dislocations, Intracranial Injury, Crushing Injury, Burn and Unspecified External Causes

Assessment 

You might say “nosocomial”; but I may say “hospital-acquired” when it comes to infections. And so, is this a linguistic technique to take some of the legal-liability and “sting” out of “never-events” terminology?

Does a term-of-art really matter to the affected patient? Suppose you were the patient?  How many podiatry mistakes are related to a lack of informed-consent? 

Conclusion 

Please comment and opine? 

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko MBA is available for medical seminars or other speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

Copyright 2008 iMBA Inc: All rights reserved, USA. Use is restricted to www.ePodiatryConsentForms.com subscribers and visitors only. No redistribution is allowed. To avoid violation of iMBA Inc copyright policy, please register for your own free membership.

Referrals: Thank you in advance for your electronic referrals to www.ePodiatryConsentForms.com

Related Information Sources:

Board Certification Preparation: www.PodiatryPrep.com

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Podiatry Reimbursement Paradigm Shifts

By Dr. David Edward Marcinko; FACFAS, MBA

At our quarterly institutional print-guide: Healthcare Organizations [Financial Management Strategies], we strive to affect positive economic change in the enterprise-wide healthcare ecosystem and to optimize patient outcomes www.HealthcareFinancials.com

And so, the Centers for Medicare and Medicaid Services (CMS) seismic decision not to reimburse “Never-Events” after October 1 2008, seems a wise one. Simply stated, in no other industry are frank mistakes reimbursed or tolerated by customers!  

Non-Payments for Never-Events 

Under the new policy, hospitals will stop requesting payment for the 27 National Quality Forum defined “Never-Events” – including wrong-site and wrong-patient surgery, patient death or disability due to wrong use of blood or blood products and medication errors – as well as related follow-up care to ameliorate such errors, if possible. And, the list will likely expand going forward.  

Developing Trends 

More imminently as a vanguard, the Massachusetts Hospital Association (MHA) announced that it will no longer charge patients or health plans for treatments required to address NEs. The announcement makes it the second state whose hospitals have voluntarily made the pledge, following a September 2007 announcement by Minnesota’s HealthPartners – who not only requires its network hospitals to report errors to state governments – but also won’t let hospitals bill patients. 

Thus, an economic trend may be developing in the industry as a strategic competitive advantage. 

Future Pressures 

In the future, all covered entities may come under similar pressure as private insurers are gradually beginning to rule out payment for NEs. And, eventually as the trend evolves, hospitals and podiatrists may end up eating the fee when more-minor errors occur; while allied healthcare providers, clinics and hospitals may adopt a proactive stand on the entirely logical issue well ahead of the deadline. 

Why Now? 

Q: Yet, why have public and private facilities and payers been indifferent to this basic business concept, until now?  

A: Perhaps the answer rests in human inertia. According to science historian Thomas Kuhn, such paradigm dislocations do not occur until defenders “can no longer evade anomalies that subvert the existing tradition.”

To date, the suggestion that domestic medicine is inefficient and wastes money was merely an inert one. But, the notion that it injures patients too; is not.  These “Never-Events”, defined as incidents that are not supposed to happen, spring more from human foibles than any evidence-based medical disaster. Of course, quality experts posit that public reporting of never-events is not meant to be punitive, but will promote correction among healthcare organizations and providers. Hence the importance of real, documented, and standardized informed consent.

The Bigger Picture 

Nevertheless, the bigger epiphany lies in revising a certain mindset that existing medical payment schemes were not only appropriate, but somehow immutable to the laws of supply-demand.   The rise of consumer directed healthcare, retail clinics and concierge medical practices seem to suggest otherwise when the patient is fully informed.  

Only time will tell which “economic behavior” is prudent of course; although the absolute prohibition against clinical never-events is clear, as we recall the admonishment “Primum non nocere”, or the fundamental medical precept of Hippocrates (ca. 460-ca.377 BC) to “First do no harm.”

Assessment

And so, how many of these never-events are germane to podiatric medicine? Maybe too many! For example, how about wrong-site, wrong-extremity, wrong-foot, wrong-toe, and wrong-patient surgery; or patient death or disability due to wrong use of blood or blood products and medication errors – as well as related follow-up care to ameliorate such errors!

Conclusion

Let us know what you think about this or any related informed consent issue? 

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko MBA is available for medical seminars or other speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

Copyright 2008 iMBA Inc: All rights reserved, USA. Use is restricted to www.ePodiatryConsentForms.com subscribers and visitors only. No redistribution is allowed. To avoid violation of iMBA Inc copyright policy, please register for your own free membership.

Related Information Sources:

Board Preparation: www.PodiatryPrep.com

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Referrals: Thank you in advance for your electronic referrals to www.ePodiatryConsentForms.com