Fam Pract Manag. 2001 Sep;8(8):57.

Translator requirements


Our practice provides translators for hearing-impaired patients in compliance with the Americans with Disabilities Act (ADA), but we’ve been asking our non-English-speaking patients to bring their own translators with them. These patients are telling us we’re required by law to provide translators for them too. I had never heard the ADA law applied to non-English-speaking patients. Is this true?


It’s true that you’re required to provide translators for your non-English-speaking patients, but the requirement is made in Title VI of the Civil Rights Act, not in the ADA. Title VI, which forbids discrimination by any program that receives money from the federal government, requires that health and social service providers give their limited-English-proficient (LEP) patients meaningful access to their services, which may entail offering translation services. These services must be provided to the patients free of charge.

Here’s how your practice can comply with both Title VI and the ADA and meet the needs of all your patients:

• Post signs stating that federal and state laws prohibit discrimination in the workplace and in the services offered.

• Create an anti-discrimination policy that includes specific instructions to your employees on how to handle situations such as caring for LEP patients. Train current and new employees on your anti-discrimination policy.

• Develop and continually update a listing of certified interpreters for hearing-impaired patients and LEP patients. Keep the numbers of over-the-phone translation services handy for emergency situations. These services are offered by many long-distance phone companies.

• If LEP patients sharing a common language represent more than 1 percent of your practice’s total patient population, consider hiring someone who speaks that language or establish and maintain contact with local church, civil and ethnic groups that may provide volunteer language-interpretation services.

• Compile and maintain a list of all patients who may require interpretation services and include in your annual budget the cost of your plan to provide these services for them.

The Department of Health and Human Services (HHS) provides policy guidance for the LEP requirement of Title VI at

Using electronic signatures


What is an electronic signature, and how can it be used by physicians?


At this stage of development, an “electronic signature” is typically just a fancy term for an ordinary password you use to attest to your identity when your computer system requires authentication for legal purposes. Your “signature” should be a different password than the one used to log into your computer. When you type in your signature, the system performs a check to verify whether you are who you claim to be. The computer’s check can be as simple as comparing the newly typed characters against a previously stored password or as elaborate as using complex mathematical calculations similar to those used in some data encryption schemes.

Physicians can use electronic signatures to sign prescriptions, hospital admission orders, progress notes, etc. and to expedite their processing. However, the standards for using electronic signatures aren’t mature enough for you to expect systems written by two different companies to acknowledge signatures from each other. Before you can use electronic signatures outside of your office, you must make sure that your practice and the outside entity receiving your data have the same software. For example, some hospitals use online systems that allow physicians to input admission orders directly while their patients are still in the office. Similarly, some pharmacies have a system for validating electronic signatures that allows physicians to send electronic prescriptions with an electronic signature.

Notice of fees for delinquent accounts


What kind of notice do I need to give patients before attaching a fee to delinquent accounts?


The AMA has an ethical policy for “interest or other reasonable charges” (available online by going to, selecting “ethical opinions” and searching for “interest charges”), which states that patients should be given advance notice of such fees in the form of posted policies in the office, general leaflets or notations on the billing statement. In order to give patients fair warning, I recommend providing each of your new patients with a general information sheet that explains this and other relevant practice policies. Physician licensure regulations and fair credit and collection practice acts in each state may also deal with this issue.

* Denotes member of FP Assist, the AAFP’s online clearinghouse for consultants and attorneys.


Copyright © 2001 by the American Academy of Family Physicians.
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