A liability form for your nosey doctor

J

John/az2

New member
The attachment is a .html file of this form.

Feel free to pass it on as it was passed on to me. ;)


FIREARMS SAFETY COUNSELING REPRESENTATION:
PHYSICIAN QUALIFICATIONS AND LIABILITY
Part One: Qualifications
I affirm that I am certified to offer (Name of Patient: ), herineafter referred to as "the Patient", qualified advice about firearms safety in the home, having received:

Specify Course(s) of Study: _____________________________________________________________
from:
Specify Institution(s) __________________________________________________________________
on:
Specify Course Completion Date(s): ______________________________________________________
resulting in:
Specify Accreditation(s), Certification(s), License(s) etc.: _______________________________________

___________________________________________________________________________________
Check one, as appropriate:
___ I represent that I have reviewed applicable scientific literature pertaining to defensive gun use and beneficial results of private firearms ownership. I further represent that I have reviewed all other relevant home safety issues with the Patient, including those relating to electricity, drains, disposals, compactors, garage doors, driveway safety, pool safety, pool fence codes and special locks for pool gates, auto safety, gas, broken glass, stored cleaning chemicals, buckets, toilets, sharp objects, garden tools, home tools, power tools, lawnmowers, lawn chemicals, scissors, needles, forks, knives, etc. I also acknowledge, by receiving this document, I have been made aware that, in his inaugural address before the American Medical Association on June 20, 2001, new president Richard Corlin, MD, admitted "What we don't know about violence and guns is literally killing us...researchers do not have the data to tell how kids get guns, if trigger locks work, what the warning signs of violence in schools and at the workplace are and other critical questions due to lack of research funding." (UPI). In spite of this admission, I represent that I have sufficient data and expertise to provide expert and clinically sound advice to patients regarding firearms in the home.
OR
___ I am knowingly engaging in Home/Firearms Safety Counseling without certification, license or formal training in Risk Management, and; I have not reviewed applicable scientific literature pertaining to defensive gun use and beneficial results of private firearms ownership.
Part Two: Liability
I have determined, from a review of my medical malpractice insurance, that if I engage in an activity for which I am not certified, such as Firearms Safety Counseling, the carrier (check one, as appropriate):
___ will
___ will not
cover lawsuits resulting from neglect, lack of qualification, etc.

Insurance Carrier name, address and policy number insuring me for firearms safety expertise:

____________________________________________________________________________________

I further warrant that, should the Patient follow my firearm safety counseling and remove from the home and/or disable firearms with trigger locks or other mechanisms, and if the patient or a family member, friend or visitor is subsequently injured or killed as a result of said removal or disabling, that my malpractice insurance and/or personal assets will cover all actual and punitive damages resulting from a lawsuit initiated by the patient, the patient's legal reprerentative, or the patient's survivors.

Signature of attesting physician and date: ___________________________________________________

Name of attesting physician (please print):__________________________________________________

Signature of patient and date: ____________________________________________________________

Name of patient (please print):____________________________________________________________

Note to patient: Indicate if physician "REFUSED TO SIGN." Ask physician to place copy in chart/medical record.

Risk Management Advice to Physicians and Malpractice Insurance Providers: Don't Borrow Trouble
© 2000 by Joe Horn crowtalk@theriver.com ...
Click to expand...

The article "Don't Borrow Trouble" follows but was too long for this post (over 1000 words) It is included in the attachment.

Enjoy!:D
 
J

John/az2

New member
Humbug...

My first attempt at attaching a file....

Hope this works.
 

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B

blades67

New member
I can't wait for my "Guns have no place in "Polite Society'" M.D. to read and sign this. I will sleep well knowing he is going to take full responsibility for my personal safety as well as that of my family and friends. :rolleyes:
 
O

Oatka

New member
Priceless!

Will print one and Xerox a bunch for my kids "just in case". They live in Utah, where you don't see much of this crap outside of the cities (yet).
 
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snakedan

New member
WONDERFUL! I have not encountered any nosey doctors yet myself but, you can bet that form will be in my pocket on any and all trips to to the doctor. If asked about firearms in my home, I will respond to the the threat!

I have several doctor friends. They all support the 2nd. One even shoots competitively and is the chief of his department. Another would rather talk about guns than medicine.

Thanks for a great post!
 
M

M1911

New member
Personally, I'm going to take a slightly different approach on this. I'm getting a physical in a couple weeks. Firearms will come up as I want to get another blood lead level test (as mine has been elevated in the past). But if he wanders into the subject of safety, I'll ask him if he is certified by the MA State Police or any other organization to teach Basic Firearms safety. And if not, exactly what are his qualifications to advise on safe storage and the MA laws (specifically Chapter 140 of the General Law) pertaining to same.

When he does the "um, er, ah, mumble, mumble..." I'll tell him that I am certified by the MA State Police and the NRA to teach firearm safety. I'm also certified the NRA and the US Army as a Range Safety Officer. I have over 160 hours of formal firearms training. So exactly what makes him qualified to counsel me on firearm safety?

M1911
 
S

Sprint Sucks

Moderator
So let me get this right...you REALLY want to piss off the guy who's going to give you a check up?

Hmmm, wait til the rubber glove comes out.
 
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Mike in VA

New member
I had a physical on Friday, I will likely make it for a few more years and got the usual advice - lose weight. I, too, requested a lead test (shoot 2X/mo. at an indoor range). My doc was interested as to why I wanted said test, so I explained that I have a carry permit, take my responsibility seriously, so I practice regularly. He thought that was fine, we got to talking guns abit, he has a couple of old Remingtons he's restoring (2 shotguns and a .22, haven't been used in years -), so I put him onto GunScrubber (to remove gunk/varnished-up old oil), Hoppe's #9, MiliTec, and other favorite potions, and a few tips on cleaning/maintenance in general.

All in all, a positive experience ('cept for the prostate check :eek: ), the blood work will be back in a week, and I don't havta have a colonoscopy for another year :D . . . M2
 
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Mal H

Staff
Mike in VA - I took my wife to see our doctor today (bad cold). He came to the waiting room door after a while and waved me back to his office. He reminded me that I needed to get a tetanus shot. He's been our Dr. for over 20 years. Well we got to talking about deer ticks around our homesteads and Lyme disease. Oddly enough that lead to talking about him and his wife coming out to visit. We had never talked about guns at all in the past, but he said out of the blue, "Should I bring my gun?" My wife said, "Not necessary, Mal's got plenty of guns." He said, "Alright!" So apparently not all physicians have the guns=bad mindset. And the strange thing is that both our doctors are in Fairfax County, at least I presume yours is also.
 
1

10CFR

New member
Great form!

If you have an anti-gun doctor who is getting him/herself involved in counselling patients about firearms, it might also be a neat idea to discreetly leave a whole pile of these forms in the waiting room magazine rack or on the coffee table with a little note: 'gunowners take one', or something to that effect. It would only stay there until staff got onto it and threw it away, but it would make the point well, and if a few others picked one up, they might copy it, etc.

-10CFR
 
J

Jamie Young

New member
WELL WHAT DO YOU KNOW I JUST GOT A PRINTER FOR MY COMPUTER!!!!!!!!!! Good Work John it'll be my first print from my Printer!!!!!:cool:
 
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