JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
AAT Pledge
Please read and select each checkbox.
By submitting this form I agree to uphold the following pledge:
* Indicates required question
Email
*
Your email
Name
*
First and last name
Your answer
POCA username (if you haven't joined POCA yet, please do so now. If someone else will be paying for your Punk level membership, please join as a House Guest. Your membership will be upgraded once payment is received).
*
Your answer
Date of Training, Training Location, Trainer(s) name
*
Your answer
As a POCA Auricular Acu-Technician (AAT), I understand, agree, and attest that I:
*
Respect the inherent dignity and worth of all human beings and will provide trauma-informed care for the empowerment of all those treated with the 5NP technique;
Will strive to understand the broader context of the structural and social determinants of health, while working to combat the stigma that surrounds people struggling with addiction and trauma;
Will hold space for resilience in all persons served;
Will implement the 5NP in a supportive and nurturing way in the recognition of the right to humane treatment of suffering directly or indirectly from addiction, trauma, and other behavioral health issues in general;
Will never withhold treatment as punishment or use 5NP in a punitive manner;
Will maintain an ethical relationship with all persons served and refer them to the appropriate service or practitioner promptly when this is not possible;
Will refrain from undertaking any activity where my personal conduct is likely to result in inferior services or constitute a violation of law;
Will adhere strictly to the established rules of confidentiality of all records, materials and knowledge concerning persons served in accordance with all current government regulations including but not limited to HIPAA;
Will not associate myself with commerce in such a way as to let it influence, or appear to influence, my attitude towards the treatment of my patients;
Will not exploit the 5NP for personal gain;
Will keep fees within the reach of and offer sliding scale fees to the general public and marginalized communities in accordance with the key concept of liberation acupuncture of the preferential option for the poor - the belief that acupuncture belongs to the people who need it the most, the people with the fewest resources, the people for whom its simplicity makes it uniquely accessible;
Will provide accurate information regarding my education, training, experience, professional affiliations, certifications and licensure;
Will not claim directly or by implication qualifications exceeding those that I have actually attained;
Will recognize the limits of my ability, providing services only in those areas where my training and experience meet recognized standards;
Acknowledge that training in the 5NP technique does not imply competency to use acupuncture in general unless so trained and licensed;
Will limit my practice of acupuncture to the 5NP technique unless I am permitted to perform acupuncture in general under the scope of practice of my professional licensure;
Will regularly evaluate my own strengths and limitations, biases and levels of effectiveness and to strive for self-improvement by seeking ongoing development through further education and training;
Will practice the 5NP in accordance with state, provincial and/or local regulations where such exist;
Will seek supervision as needed and as required by state, provincial and/or local regulations;
Will respect the integrity of other forms of healthcare and to make efforts to build bridges and develop collaborative relationships to achieve the best possible care for individual patients;
Will recommend the 5NP in conjunction with appropriate counseling and supportive services;
Always recognize that I have assumed a serious social and ethical responsibility due to the intimate nature of my work that significantly touches upon the lives of other human beings.
Required
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of People's Organization of Community Acupuncture.
Report Abuse
Forms
