CHAPTER VII: DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
SUBCHAPTER a: ADMINISTRATIVE RULES
PART 1130 ADMINISTRATIVE PROCEDURES FOR GENERAL PROFESSIONAL REGULATION UNDER THE ADMINISTRATIVE CODE
SECTION 1130.APPENDIX A NOTICE OF ORDER REQUIRING CHAPERONE
Section 1130.APPENDIX A Notice of Order Requiring Chaperone
NOTICE OF ORDER REQUIRING CHAPERONE
The Illinois Department of Financial and Professional Regulation has ordered ***INSERT PRACTITIONER'S NAME*** to have a chaperone who is a licensed health care worker present during all patient encounters pending the outcome of criminal charges against him/her. In compliance with this Order, please sign below to acknowledge that you have received a copy of this notice.
The health care worker is presumed innocent until proven guilty of the charges.
Patient:
_____________________________________________________________
Print Name
__________________________________ ___________________
Signature Date
Chaperone:
_____________________________________________________________
Print Name
__________________________________ ___________________
Signature Date
(Source: Added at 37 Ill. Reg. 1192, effective February 1, 2013)