PENNSYLVANIA · CONTRACT FOR CARE · DOCUMENT RECORD
Advanced Pain Medicine: document versus identified state authority
Document: Historical 2018 patient packet compared with current public intake packet. Version: 7-10-18 in historical filename; current PDF metadata names 1-23-25.
Status: Historical financial policy; current opioid agreement missing.
The patient-form link now opens a six-page intake packet at a 2026/04 URL. The older 2018 packet’s financial terms are retained as historical evidence and are not asserted to govern patients today. The current opioid agreement was not obtained.
Read the complete original public document · Find the listed offices
Source-located terms
The table summarizes the clauses. Page references use PDF viewer pages, with clause numbers where printed. Follow the source link for the complete exact wording. Classifications are comparisons with the authority identified below, not determinations of enforceability or proof of patient outcomes.
| Source location | Document requirement or consequence — summary | Classification |
|---|---|---|
| PDF p.16, COPAYS | Copay before seeing a provider; inability to pay may require rescheduling. | Institution-specific policy |
| PDF p.16, HMO/PPO | Missing required insurance referral may cause rescheduling or personal billing. | Institution-specific policy |
| PDF p.16, NO INSURANCE | Uninsured services require full payment on appointment day; no payment arrangements. | Institution-specific policy |
| PDF p.16, MEDICAL RECORDS | Lists $20 record/form charges and withholding records while account balance remains. | Unresolved / legal review |
| PDF p.17, NO SHOW APPOINTMENTS | Late cancellation or missed visits may trigger fees or practice termination. | Institution-specific policy |
| PDF p.17, financial acknowledgment | Failure to follow financial policy may suspend services or lead to dismissal. | Institution-specific policy |
| PDF p.19, release authorization | Says this information-release authorization cannot be required to receive treatment. | Unresolved / legal review |
What the government requirement establishes
35 Pa.C.S. §52B02 requires covered treatment agreements to address goals, medically necessary targeted testing consent, prescribed use, no sharing, other controlled substances, reasons for changing or stopping therapy and disposal. Subsections (c)–(e) address testing and documented exceptions. Those required subjects do not make every facility-specific deadline, fee, restriction or discharge outcome mandatory.
28 Pa. Code §26.4 addresses testing, alternative testing for medical necessity, agreement termination and continuity of care. DOH implementation guidance says Act 112 does not require a particular pharmacy or targeted blood testing. Specific program, payer, privacy, professional or consent authorities may require further review; none are inferred from a form’s introductory assertion that laws apply.
Version comparison
The current Patient Form link opens a six-page intake packet. PDF metadata names a January 23, 2025 packet; the 2026/04 URL is upload context, not proof of an effective date. It contains history, medications, pain questions and provider review fields. The older financial policy below is not asserted to govern current patients.
The newer packet’s Greensburg address also differs from the current office directory. Current contract, financial policy, location and implementation need practice confirmation.
Refusal, inability to comply and current use
The tables report consequences expressly described by the source, including possible prescribing cessation, medication gaps, rescheduling or dismissal where stated. They do not establish what happened to a particular patient. Current signed copies, exception policies, accommodations, taper/transfer procedures and office-specific practice confirmation remain needed. Unresolved privacy, cannabis, payment or legal-scope questions remain for legal review.
Practice: correct this record or supply the current version
Patient or practice: submit a contract, policy or newer version
Research date: October 12, 2026. Methodology and version history.