Is any link NOT working? Please draw to the attention of IFEHC (info@ifehc.com).
Interested in expediting service? This section shows the documents with which you need to be familiar. You will need these whether you are planning to visit Idaho Falls Employment Health Clinic's Accessible Health Clinic-Internal Medicine Clinic or Employment Health Clinic (particularly DOT-CDL medical exams).
IFEHC declares all documents on this page (as well as on this website), even modifications to existing documents, intellectual property to the extent that unique formatting and our supplemental content are enforceable.
Importantly, please note the following. In accepting services, you implicitly consent to the applicable policies. In continuing to seek services, you implicitly consent to any updates to policies.
IFEHC, PLLC draws attention changes to pertinent documents. As made abundantly clear, patients/examinees are responsible for staying up-to-date with pertinent changes. IFEHC, PLLC does not have the resources to contact every individual when there are changes. IFEHC, PLLC values transparency. It does its best to list below the newest editions of various documents. In this section, IFEHC provides a list of updates to the most used documents.
IFEHC, PLLC reminds everyone of the following. In receiving services, patients/examinees (including prospective individuals) consent to applicable policies. In continuing to seek services, patients/examinees consent to applicable updates in policies.
Please click the link below to access the list of the most recent versions of documents.
If you feel you cannot assume the burden of staying up-to-date, please contact IFEHC's Compliance Officer (HIPAA@IFEHC.com) to make alternative arrangements.
Posted 09/12/2024. Revised 09/13/2024, 09/21/2024. Document updated 10/02/2024.
This document is intended to replace most of the core paperwork that needs to be signed. Upon patient/examinee request; it can be completed by e-mail, text message, or any medium of his/her choice. Anyone who chooses to complete this document by an unencrypted digital medium is hereby advised that unencrypted communications are not considered secure. It is acceptable to communicate by unencrypted communications as long as s/he accepts the inherent risk(s).
This document is an abridged version of the Acknowledgment of Policies, which it now (as of 09/21/2024) replaces entirely. In response to feedback from patients and examinees, IFEHC has simplified the check-in process. To expedite check-in, we give one document that indicates acknowledgment of (and consent to) the major documents given.
This document also replaces the Acknowledgment of the Notice of Privacy Practices.
As of 09/21/2024, we draw attention that we now ask patients/examinees to acknowledge our new Third Party Disclosure Statement.
Also of note is we keep making updates to make as clear as possible that no one is compelled to waive rights as a condition for care. We have safeguards such as allowing individuals to propose proactively applying amendments at the time of signing or afterward. Consent to services may also be revoked.
Revised 09/13/2024, 09/21/2024. Document updated 10/02/2024.
We are posting the seventh edition of the Service Agreement. You are advised that many clarifications are provided. This applies to both pro bono (free with no expectation of compensation) and compensated services.
In signing this document, you consent to the terms and conditions set forth in the other documents on this page. All efforts will be made to obtain your signature. However, failure to obtain your signature does NOT make the other documents inapplicable.
Be advised that committing any crimes on premises, including the use of fraud to obtain services, effectively nullifies any expectations you have from signing the contract or any other document referenced. Good faith belief of such crimes is grounds for IFEHC to investigate and involve appropriate third parties.
Updated 05/14/2023, 02/03/2024.
IFEHC complies with all applicable privacy laws. However, be advised that there are exceptions prescribed by statutes. They specify circumstances when there is a duty to disclose to other parties (e.g., the employer or the public) need-to-know information. Should such a circumstance arise, IFEHC will make all efforts to limit the scope of information disclosed to what is legally required. IFEHC, PLLC asks its patients/examinees to provide voluntary consent to cooperating with third parties. This consent can be revoked and/or amended. Failure to consent to this provision will not result in the denial of healthcare. However, lack of consent will not prevent IFEHC from cooperating with applicable laws and codes of ethics. To access IFEHC's Privacy policy, click the link below. For additional questions, reach the HIPAA Compliance Officer at HIPAA@IFEHC.com.
Revised 09/12/2024
This document is a summary of Document #134: IFEHC's Privacy Practices Policy. Patients (or their representatives) must sign an acknowledgement of receiving and understanding this policy (Document #136) in order to receive services. Please be advised that; if you are applying for a DOT-CDL medical card, the FMCSA-NRCME has its own electronic portal and policies governing the storage of your data. IFEHC also draws to your attention that this version grants IFEHC additional authority to cooperate with regulators, law enforcement, and any other third party with legitimate interest. In particular, this revision states that crimes that are committed to influence outcomes are exempt from HIPAA. For additional questions, reach the HIPAA Compliance Officer at HIPAA@IFEHC.com.
If you seek IFEHC's General Medical Clinic's (the pro bono clinic's) services, you agree to release IFEHC from liability from circumstances that are outside IFEHC's control. You also agree to assume liability for any damages incurred within the scope of IFEHC's work when IFEHC performs work off-premises. Even if our insurance covers damages off-premises, you may still be asked to cover it and agree to do so if asked.
Updated 09/08/2024, 09/12/2024
Telehealth is the provision of healthcare using communications technology. Informed consent for receiving telehealth services. Overview of responsibilities of physician and patient. In-person appointments are strongly encouraged after telehealth visits.
Most state regulators require the following: that you prove your current jurisdiction, that the provider verifies your identification, that there be backup plans in case of equipment failure, and that there be backup plans in case it is determined you are experiencing a medical emergency. Obviously; if you lie about your location, you alone are responsible for any adverse outcomes of any emergencies that cannot be handled remotely. Most regulators want it known to patients that they can expect standard of care, including access to their medical records from the telehealth session. IFEHC does NOT consider the session to have begun until these terms (also discussed in the informed consent) are agreed.
You are strongly advised to have as much objective information available as possible. This includes temperature, blood pressure, and pulse. Most pharmacies offer free use of sphygmomanometers (blood pressure cuffs).
DOT's standards are going up, and IFEHC is enforcing them!
The Federal Motor Carrier Safety Administration (FMCSA) has announced a number of changes to the Federal Motor Carrier Safety Regulations (FMCSR) that take effect June 23, 2025. In addition, FMCSA has also made clarifications regarding the standards currently in place. As of December 18, 2023; Medical Director Dr. Boren completed FMCSA's periodic (every five years) training, and IFEHC, PLLC has begun implementing these changes and continued enforcing existing rules that are clarified in the FMCSA-sponsored training modules. Referencing the changes to the FMCSR means the following largely "come from above", and we would like to think we are developing a reputation for being the most compliant DOT-CDL medical card clinic in the industry. Drivers and their employers have given us feedback that we are "tough but fair". The document (please click the link below) comments on the format of cards, special forms (also attached to the document), and clarifications.
If you are a DOT-CDL Examinee, you will be told about the following document and asked to acknowledge this document. The link to the two-page acknowledgment document is found on the General Documents Page (under the menu Patients). Even if IFEHC does not ask you to sign the Acknowledgment, you are presumed to have agreed to the Acknowledgment by receiving services. In our interpretation of statutes and standard of care, most of the terms to which you are being asked to agree are what any reputable and compliant provider would expect. In our interpretation, they thus constitute the stipulations of an implied warranty.
Although you are allowed to park a CMV in our parking lot, you are hereby advised it is not a good idea to drive a CMV to the appointment. If you fail the examination, DOT will NOT allow you to drive the CMV back.
This entry was moved to this webpage on 09/08/2024. This document was updated 09/12/2024.
The following is NOT an official component of the DOT process. It is provided as a courtesy by IFEHC, PLLC.
IFEHC, PLLC understands the importance of balancing the needs of the driver with those of the public. The Medical Director, at his sole discretion, is willing to allow certain examinees with borderline findings to enter voluntarily into private monitoring. Such participants agree to periodic monitoring. We are not obligated to provide this service to anyone. We remind everyone that a DOT medical card is a privilege, NOT a right, and an important premise of this agreement is that public safety is such an important priority as to place the burden on the examinee to prove that s/he is fit for duty.
Below is a link to the informed consent document for private monitoring. This document discusses the purpose, the alternatives, the benefits, and the risks of entering into this agreement. Participants can revoke this consent at any time but are advised that revocation necessarily requires that they accept alternative arrangement(s) applicable at the time of revocation. Neither Dr. Boren nor IFEHC, PLLC asks anyone to enter into this agreement; it is offered to certain examinees at the sole discretion of the Medical Director. Anyone who enters into this agreement does so voluntarily and certifies that s/he is able and willing to comply with its stipulations unless specifically noted otherwise. This is a pro bono service, and participation requires you to acknowledge the waiver to civil claims of liability stipulated in 39 ISC 77 and as discussed in IFEHC's Free Clinic Compliance Statement. While signing a Release of Information continues to be voluntary and revocable, it is not possible to be part of the program if clinicians are not permitted to perform their essential functions.
Posted 09/14/2024. Updated 09/21/2024, 10/02/2024.
This document (#405) is no longer used. It is replaced by [406] IFEHC's Acknowledgment of Policies - Abridged. If you previously signed this document or consented to it and wish to access it, you should reach IFEHC's HIPAA Compliance Officer (HIPAA@IFEHC.com).
Revised 09/21/2024.
As of October 2, 2024; this document is no longer used. Its contents are now part of IFEHC's Acknowledgment of Policies - Abridged. This link directs you to IFEHC Document #318: DOT Updates Acknowledgment. This document acknowledges having read and understood IFEHC Document #317: DOT Medical Card Legislative Updates & Clarifications as w
As of October 2, 2024; this document is no longer used. Its contents are now part of IFEHC's Acknowledgment of Policies - Abridged. This link directs you to IFEHC Document #318: DOT Updates Acknowledgment. This document acknowledges having read and understood IFEHC Document #317: DOT Medical Card Legislative Updates & Clarifications as well as other applicable documents such as IFEHC Document #135: Notice of Privacy Practices. This two-page document makes a number of clarifications - notably including how the examiner-examinee relationship is different from the traditional therapeutic relationship. You can currently access this document by going to the Home Page. It also clarifies obligations on the part of the driver, such as to be forthcoming and proactive about providing material updates that can adversely affect Medical Examiner determinations.
This document was updated 09/12/2024. This final post was made 10/02/2024.
You are being requested to acknowledge, NOT to consent to, the following statement. This means your agreement will not affect whether or not you receive services. There are three reasons this statement is produced. The first is to give fair warning to all patients/examinees that there are circumstances under which providers are obligated
You are being requested to acknowledge, NOT to consent to, the following statement. This means your agreement will not affect whether or not you receive services. There are three reasons this statement is produced. The first is to give fair warning to all patients/examinees that there are circumstances under which providers are obligated to make reports to third parties. The second is to discuss the circumstances in which third parties have a legitimate need to know information, the ambiguity of applicable statutes, and how we interpret applicable statutes and codes of ethics. The third is to make sure you are unambiguously clear how our clinic plans to handle such circumstances.
This statement was produced because the unfortunate circumstance of reporting to third parties adverse information has arisen. We believe the best way to handle this circumstance is to make known our expectations from the start. This document discusses some of the more common, foreseeable circumstances. Unfortunately, it is unlikely to be exhaustive.
Posted 09/21/2024.
Please click below to a link to IFEHC's Informed Consent for Neurocognitive Testing. For certain tests falling under classification as sensitive information, you must sign certain documentation which examinees are advised to view at least 24 hours in advance. In our experience, most individuals being evaluated are examinees, NOT patients.
Please click below to a link to IFEHC's Informed Consent for Neurocognitive Testing. For certain tests falling under classification as sensitive information, you must sign certain documentation which examinees are advised to view at least 24 hours in advance. In our experience, most individuals being evaluated are examinees, NOT patients. That means there may not be a therapeutic (treating) relationship. In such circumstances, the evaluator functions as an independent medical examiner. It is important to avoid actions that could be construed as attempts to compromise the integrity of the evaluation for secondary gain. Please be aware that you are bound by the rules of any third party who sent you to us. That includes the scope of the evaluation and even access to your results. Nonetheless, we do everything we can to make sure examinees are informed. For that reason, we would like you to review the Informed Consent document carefully. This discusses the context and purpose, the credentials of IFEHC, your rights, responsibilities, the risks, and what IFEHC does to mitigate the risks.
Updated 09/13/2024.
Spirometry is a test of lung function - specifically how much air the lungs can hold and how well the airways conduct. To ensure the most accurate results as well as suitability for diagnostic testing, IFEHC requires patients and examinees to complete this questionnaire prior to spirometry testing. In addition, patients and examinees shou
Spirometry is a test of lung function - specifically how much air the lungs can hold and how well the airways conduct. To ensure the most accurate results as well as suitability for diagnostic testing, IFEHC requires patients and examinees to complete this questionnaire prior to spirometry testing. In addition, patients and examinees should indicate to the clinic any changes in symptoms during or after testing.
Since November 1, 2021; IFEHC has announced the right to collect 100% refundable deposits. To date, IFEHC's Medical Director has not enforced this rule. He does not foresee doing so in the immediate future. However, please be advised IFEHC has the right to enforce this rule at any point. If, for instance, the Medical Director is out of to
Since November 1, 2021; IFEHC has announced the right to collect 100% refundable deposits. To date, IFEHC's Medical Director has not enforced this rule. He does not foresee doing so in the immediate future. However, please be advised IFEHC has the right to enforce this rule at any point. If, for instance, the Medical Director is out of town; it is reasonable to expect to be assessed a 100% refundable deposit if the Medical Director changes his plans to accommodate your schedule. For details, please see the list of prices.
During the peak of the novel coronavirus (CoVid19) outbreak, IFEHC will take all possible measures to reduce clinic volume. If IFEHC agrees to schedule a physical exam, the examinee needs to answer basic CoVid19 screening questions to assess for risk.
IFEHC's After Visit Disclaimers is Document #430; drafted on April 5, 2023. We no longer require new and current patients and examinees to acknowledge this document because the contents are repeated elsewhere. Former patients and examinees who did not continue to seek care on or after September 8, 2024 are still obligated to abide by thos
IFEHC's After Visit Disclaimers is Document #430; drafted on April 5, 2023. We no longer require new and current patients and examinees to acknowledge this document because the contents are repeated elsewhere. Former patients and examinees who did not continue to seek care on or after September 8, 2024 are still obligated to abide by those disclaimers. This document can be accessed by reaching IFEHC's HIPAA Compliance Officer (HIPAA@IFEHC.com).
Updated 09/08/2024.
No action, other than acknowledging receipt of this communication and confirming the appointment, is required. However, you are encouraged to read this e-mail. It is a boilerplate e-mail. This means it is not personal and that the contents are standardized and sent to all examinees. Any revisions made are subsequently applied to everyone else who receives it. However; if you wish to save time during the visit, you are encouraged to do the following. (1) You may want to complete pages 1 and 2 only of the DOT Long Form (MCSA-5875). It can be found at this link. Specifically only complete the blue boxes. That means to leave blank the last box (colored green) on page 2. You will notice this is a Federal form. That means it is NOT my clinic’s form. These are topics I am required by the DOT to address. (2) You may also read this entire e-mail, confirm that the links work, and sign it in lieu of signing two of the acknowledgments. Please remember that you may propose proactively applying amendments both at the time of signing and afterwards and that no opinions stated in this document or during the session constitute legal advice.
The focus of this communication is to provide links to applicable policies and to draw drivers’ attention to important topics that prior examinees have overlooked. This communication is definitely intended to minimize gaps in expectations. However, it is not intended to be exhaustive. The organization of this communication is as follows. (1) I state unambiguously that this service is pro bono and the applicable statutory requirements. (2) I give a link to our most recent applicable documents and forms. (3) I discuss what to expect of the examination, (4) I discuss applicable ethics - summarized as non-legal advice to be aware of the burden of proof, the nontherapeutic relationship, to tell the truth, and to avoid optics of "doctor shopping". (5) I discuss a final legal point - disclosures to third parties.
We have noticed that it can be slightly overwhelming for people getting a DOT-CDL physical examination, especially if people have not had an exam before.
Again; effective November 1, 2021; new examinees will generally be assessed a 100% refundable deposit of $50.
Go to the Resources section of this menu (Patients) for a study guide on the DOT-CDL physical examination process. Or click below for a link to the document.
Get started by completing the DOT-CDL MCSA-5875 Medical Exam Report Form (MERF). To make the form interactive (fillable), click the download button. You are advised to request an encrypted form if you wish to e-mail the completed questionnaire.
This file, MCSA-5876, is for the use of personnel only. It is encrypted.
This document is NOT applicable for most employment health holders. It is a resource for individuals who are looking for Substance Abuse Professionals (SAP's). Those people are exclusively those who fail DOT drug tests or have been mandated by their employer to seek assistance.
List of DOT-certified substance abuse professionals. Accessed from NAADAC's directory on September 7, 2021. According to NAADAC: "[T]he following directory lists people who have successfully obtained the U.S. Department of Transportation's Substance Abuse Professionals (SAP) Qualification through NAADAC's Substance Abuse Professional's U.S. DOT Alcohol and Drug Testing Regulation Qualification Independent Study Course."
Disclaimer that IFEHC does NOT endorse the contents of this directory. Because IFEHC cannot routinely update the list, we recommend you check NAADAC directly to verify the provider is still listed and confirm with the provider when scheduling an appointment. Are you a new DOT-certified SAP serving the non-Coastal West who wants to be listed? Contact IFEHC (info@IFEHC.com)!
Additional comment: it should be rare that anyone other than employers or other healthcare professionals needs this list. SAP's apply when an individual has failed a DOT drug screen. It is the employer's legal obligation to provide a copy of this list. If your employer tells you to go to an SAP but does not provide a list of SAP's, we suggest seeking legal counsel.
The following is the OSHA questionnaire for using a respirator. Simply complete it and submit it. Click the download button on the PDF to access the interactive (fillable) form. You are advised to request an encrypted form if you wish to e-mail the completed questionnaire.
Again; effective November 1, 2021; new patients to our free (as opposed to affordable or low cost) health clinic-adult internal medicine will generally be assessed a 100% refundable deposit of $15.
Provide general information about why visiting and pertinent information about medical history.
This document effectively serves as informed consent for the use of controlled substances as well as documentation of compliance with applicable statutes as well as best practices. IFEHC, PLLC would like to acknowledge the Oklahoma State Board of Medical Licensure & Supervision (AKA "The Oklahoma Medical Board") for giving providers a s
This document effectively serves as informed consent for the use of controlled substances as well as documentation of compliance with applicable statutes as well as best practices. IFEHC, PLLC would like to acknowledge the Oklahoma State Board of Medical Licensure & Supervision (AKA "The Oklahoma Medical Board") for giving providers a sample Opioid Therapy Patient-Provider Agreement. Out of an overabundance of caution; IFEHC, PLLC has modified this agreement to include all controlled substance therapies. Anyone placed on any chronic controlled substance will be asked to sign this agreement. Because it is good practice to ensure mutual expectations, we will likely encourage even individuals receiving short-term prescriptions to sign this document. A disclaimer is in effect that OSBMLS does NOT endorse this modified document.
IFEHC's Medical Director recently decided IFEHC's Free Health Clinic-Adult Internal Medicine can prescribe controlled substances in limited circumstances. IFEHC's Medical Director and Compliance Officer determined that IFEHC must require anyone taking controlled substances to enter into a therapeutic agreement. Therapeutic contracts are a
IFEHC's Medical Director recently decided IFEHC's Free Health Clinic-Adult Internal Medicine can prescribe controlled substances in limited circumstances. IFEHC's Medical Director and Compliance Officer determined that IFEHC must require anyone taking controlled substances to enter into a therapeutic agreement. Therapeutic contracts are advised by most states' Boards of Pharmacy. This document is publicly available and made known any time prescriptions for regulated substances are made. Thus, all that signing this document shows is that you are acting in good faith. A lack of signature does not vindicate you from the consequences of violating this agreement.
We draw a few additional points to your attention. Your HIPAA rights are substantially restricted. Part of prescribers' responsibilities is to cooperate with government agencies and/or law enforcement in efforts to curb abuse. Although you are entitled to certain privacy protections, those protections fall outside HIPAA. In addition; in IFEHC's interpretation, HIPAA does NOT apply to access of information. You will not be permitted access to any regulatory reports unless regulators mandate IFEHC disclose them. In addition, IFEHC produces screening documents that it regards in the public's interest. For the reason that such screening is designed to protect the public (viz, disclosure could compromise surveillance efforts), this/these document(s) are not considered part of the designated record set (DRS). Under most circumstances, these will not be released as part of medical records requests.
In summary; Idaho Falls Employment Clinic, PLLC, or IFEHC believes strongly in the importance of building trust with patients, putting their interest first, and taking all possible steps to advocate for them. However, IFEHC believes in doing so within the confines of the law and that its obligations last as long as fundamental terms of contract have not been violated. To this effect, IFEHC makes known it is eager to develop a reputation among the regulators and the community in general for strictly enforcing applicable laws and making all good faith efforts to protect the public at large.
This document supplements IFEHC Document #223: Therapeutic Contract. A signature on this document covers both the general stipulations of that document and the specific stipulations of this document. This document addresses your individual circumstances. It covers bother therapeutic and forensic (i.e., legal) aspects of prescribing. You
This document supplements IFEHC Document #223: Therapeutic Contract. A signature on this document covers both the general stipulations of that document and the specific stipulations of this document. This document addresses your individual circumstances. It covers bother therapeutic and forensic (i.e., legal) aspects of prescribing. You hereby agree that this information can be exchanged with other prescribers, pharmacies, and regulatory agencies. For regulated professions (such as with the Department of Transportation), this can include contacting your employer. Exchange of information means IFEHC can obtain as well as volunteer information. You also agree to share this agreement with any third party involved in enforcing it.
It is clear to any reasonable person that IFEHC attempts to be thorough in producing this document. Due to the length of this document and the necessity of tailoring it to each patient, it is foreseeable that not all of it will be completed the first visit. You agree to be cooperative and supply missing information and that not having completed. Indeed; many of the questions asked are foreseeable topics that will eventually be discussed. As discussed in this document, incomplete written answers may be subject to a nonreciprocal verbal contract. You are responsible for complying with IFEHC's guidelines and notifying in a timely manner (defined below) IFEHC of any material updates that affect your ability to comply.
For your convenience, we provide a link to the webpage of the Idaho Board of Pharmacy (IBOP). Should we discover any violations within the jurisdiction of IBOP, we plan to report them to their compliance officers.
For more privacy policies and forms, click below visit IFEHC's HIPAA Compliance page.
Idaho Falls Employment Health Clinic (IFEHC)
2539 Channing Way Ste 260, Idaho Falls, ID 83404-7558 in Idaho Falls Medical District
T 208-932-4932, F 208-932-4935
All contents on this site, including downloadable files (unless otherwise credited), are the intellectual property of D.M. Boren, M.D., the Medical Director. Materials may be used for private consumption. Written authorization must be sought for each commercial use. D.M. Boren, M.D. and Idaho Falls Employment Health Clinic, PLLC must be given intellectual credit each time Dr. Boren’s materials are reproduced for any purpose (whether private or commercial).