Wang’s Chinese Herbs 王氏医药 加州替代和补充保健声明和同意书
在SB 577第一款立法机关做了如下结论: “基于美国医学研究院的综合报告和其他研究，包括在新英格兰医学杂志发表的一篇文章，数以百万计的加州人，也许超过五百万，目前接受补充和替代医疗保健从业人员的服务。这些研究进一步表明接受和使用补充和替代医疗保健从业人员服务的人口跨越各种不同年龄，种族和社会经济条件... 因此，立法机关承认替代和补充医疗保健并提供指导性框架和通知。
Wang’s Chinese Herbs（王氏中药），是KingXo有限责任公司的子公司，注册于美国食品药品监督管理局，用中华民族传统中医的理，法，方，药，为人们提供替代和补充医疗保健服务，主要是通过中药穴位外敷为人们提供美容，塑身和养生保健服务。
Wang’s Chinese Herbs（王氏中药）穴位外敷系列产品是参悟中华民族先圣智慧：八卦，河图，太极阴阳五行学说，《 黄帝内经》，《神农本草经》，《伤寒论》，和后世诸代医家的实效临床经验及现代纳米技术而得。特点如下：1. 结合现代纳米生物技术和传统中药，外治于人体，有效持久地调节机体功能。 2. 突破中药必须口服的局限. 疗效确切，安全可靠，灵活方便，老少咸宜。
Wang’s Chinese Herbs（王氏中药）唯一从业者是王庆才。他不是内科医师，外科医生，或有执照的针灸师。接触和使用王庆才和Wang’s Chinese Herbs（王氏中药）的任何中药都是我自己采取的自由行动， 我清楚并承担全部责任。我特此接受在我们合作过程中的任何可能的损失或损害并承担任何可能的责任，并永不追究王庆才和Wang’s Chinese Herbs（王氏中药）的任何责任。
我确认，我只是寻找或使用替代和补充医疗保健，如果我想要诊断，治疗或针灸任何疾病，我一定会咨询执业内科医师，外科医生或针灸师。我承认，王庆才或Wang’s Chinese Herbs（王氏中药）不是在加利福尼亚州有执照的医生，保健医生，针灸医生或医疗机构。
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Wang’s Chinese Herbs 王氏医药
CALIFORNIA ALTERNATIVE AND COMPLEMENTARY HEALTH CARE NOTICE AND CONSENT FORM
The California Legislature enacted California Senate Bill SB-577 that affirms the right of citizens to obtain Alternative and Complementary Health Care from practitioners other than licensed Physicians and Surgeons or other licensed health professions.
In Paragraph 1 of SB 577 the Legislature made a Finding that:
"Based upon a comprehensive report by the National Institute of Medicine and other studies, including a study published by the New England Journal of Medicine, it is evident that millions of Californians, perhaps more than five million, are presently receiving a substantial volume of health care services from complementary and alternative health care practitioners. Those studies further indicate that individuals utilizing complementary and alternative health care services cut across a wide variety of age, ethnic, socioeconomic, and other demographic categories."..... Thus, the Legislature wanted to recognize Alternative and Complementary Health Care and provide a framework of guidelines and notices.
Pursuant to this Act of the Legislature, Alternative and Complementary Health Care Practitioners must inform clients that they are not Physicians and Surgeons or allied licensed practitioners and that for a western medical diagnosis and treatment, including, but not limited to, prescription drugs, surgery and the treatment of fractures, lacerations and abrasions, the clients must see an MD, Physician or Surgeon. The notice must also state the nature of the Alternative and Complementary Health Care practice that is being provided.
The theory of Traditional Chinese Medicine believes that Health & balanced Qi is essential for human’s health and it is achieved through a harmonious relationship with nature, meaningful interactions with others. All physical or emotional transformations of the body depend on the correct and balanced function of the Qi.
Wang’s Chinese Herbs (王氏医药), which is a DBA of kingxo LLC (registered in U. S. Food and Drug Administration), is operated by Qingcai Wang only. He is not a licensed Physician, Surgeon or Acupuncturist. The herbal pouch attached to the acupuncture points of body will improve the conditions of body. All herbs are to be applied or attached to outside of the body and they are prohibited to be taken by mouth under any circumstances.
I (patient) understand that rather than western medical advice or treatment, I am seeking alternative treatment in the form of Traditional Chinese Medicine. Under no circumstances, should any suggestions be taken as a diagnosis or direction against the advice of a licensed physical or medical care professional.
I confirm that I am seeking Alternative and Complementary Health Care and advice in natural health only, and if I desire a diagnosis, treatment or acupuncture from Western Medicine, I must consult a licensed Physician, Surgeon or Acupuncturist. I acknowledge that Qingcai Wang or Wang’s Chinese Herbs (王氏医药）is not a licensed medical doctor, acupuncturist or medical institution in the State of California.
I hereby accept full responsibility for any actions taken by myself concerning any herbs with Qingcai Wang and Wang’s Chinese Herbs (王氏医药). I hereby release the above named from any liability resulting in any possible damages or loss during our association. I acknowledge that I have read and understood all that is disclosed here.
Name (Print): ____________ Signature: _________ Date: __________
Sex: _______ Age: ____ Occupation: _______ Phone: ______