49 Pa. Code § 23.101
(c) Guidelines for disclosure.
(1) Posting notice of disclosure requirement. It is recommended that compliance with the disclosure requirement include the prominent posting of a printed notice at least 8 1/2" x 11", legible from 3 feet, posted in the patient waiting area, as follows:
‘‘Treatment in this office may include a referral for further health-related services, devices or products. Pennsylvania law requires any health-care practitioner to disclose to you any financial interest he has in any health-care facility in which he recommends further health-related services, devices or products. (Act 66-1988)’’
(2) Written notice. When a licensee of the Board makes such a referral, the licensee or a delegate should advise the patient and retain the following document in the patient’s file:
‘‘I have been referred to
. I understand that my (licensee’s profession) has a financial interest in this business, and that I am free to choose an alternate provider.’’ (Signature of Patient)
The provisions of this § 23.101 adopted June 26, 1992, effective June 27, 1992, 22 Pa.B. 3187.