I did hear Fl. on another forum,but the way I see it:
"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):___________________________________________ _________________
Patient: Indicate if physician "REFUSED TO SIGN." Have physician place a copy in your chart/medical record."
The only exception I would have would be if the person asking was an LEO, in the performance of their duties. Then, I'll be truthful. (Carefully).
