Best Practices: PARQ in Clinical Record Keeping

Informed consent is a process involving verbal discussion as well as proper documentation. CHP recommends as a “best practice” that informed consent be fully documented and included in the clinical file.

One common option for documenting informed consent is noting the acronym “PARQ” which can be written in the patient’s chart indicating that the provider has explained the procedures (P), viable alternatives (A), material risks (R), if any, and has asked if the patient has any questions (Q). “PARQ” should be noted prior to the implementation of any treatment. If the patient requests further information or has specific questions, the provider can underline the PARQ chart notation to reflect the patient’s request. The provider should note the particular question and note the more detailed information provided. While this is an appropriate method of documenting that this process has occurred, there is no substitute for the patient’s written confirmation of those facts.

It is also recommended that the patient execute some document acknowledging that they have been part of an informed consent process, the material risks have been disclosed including a description of those risks and that the patient has agreed (“consented”) to the procedures understanding any risks inherent to that procedure. This could be accomplished using a prepared written consent form that must be signed by the patient and should be signed by the doctor. Again, it is important to note that practitioners should not rely exclusively on those forms and must communicate directly with the patients.

As new conditions occur that may require different evaluation procedures or different treatment procedures, additional informed consent should be obtained from the patient. In addition, consent given to one physician is not consent for any other physician unless the patient agrees to the substitute. This assent to the substitute physician should be noted in the clinical record.

The Minor Patient (In the US, minor is legally defined as a person under the age of 18)
As with all patients, informed consent is required for minor patients. There are different considerations required based on the type of provider delivering the service, e.g. DC, MD, as well as the services that are being provided, e.g. chiropractic adjustments, reproductive healthcare. For the purposes of Best Practices, it is recommended that the provider review the specific statutes or rules regarding obtaining informed consent from a parent/legal guardian or the minor patient, whichever is appropriate, that applies to the services rendered in the state in which they practice.

Want more information on record keeping or other best practices for integrative healthcare providers? Search “best practices” on this site to read more in this series of articles.