Policies
Care delivery:
Treatment will be conducted via telemedicine only. This reduces barriers to accessing mental health care, but it limits my ability to assess your vital signs including height, weight, pulse rate and blood pressure. These are basic indicators of health which may be impacted by your treatment, so it is important to be able to assess these measurements regularly. With that in mind, I request that each individual I treat via telemedicine obtain an accurate scale to measure your weight and automatic sphygmomanometer (blood-pressure monitor), if you do not already own these. Each of these can be purchased for approximately $30. I request that each individual measure and record their weight, pulse and blood-pressure prior to each visit.
Health monitoring and collaboration of care:
I request that you provide a release of information for me to discuss issues relevant to your health and treatment with your primary care provider, psychotherapist or counselor and all other relevant healthcare providers. I also request that you provide me copies of any relevant lab-work results and investigative studies (electrocardiograms, CT scans, MRIs, sleep studies, etc.) ordered by other health care providers during the course of our therapeutic relationship. This collaboration in care will allow me to provide care in the safest and most efficient way.
Controlled substances:
Current legislation (Ryan Haight Online Pharmacy Consumer Protection Act of 2008) prohibits me from prescribing controlled-substances to individuals via telemedicine. Several of these are used commonly in psychiatric care for ADHD, certain types of anxiety disorders, insomnia and to treat side-effects to other therapeutic agents used in this field. For this reason, I do not treat ADHD via telemedicine. If you are looking for standard and first-line treatment for ADHD I am not the right resource for you. Having said this, there are non-stimulant/non-controlled treatments for ADHD which I do provide, as appropriate, for individuals with ADHD.
The following is a link to controlled-substances which I do not prescribe via telemedicine: Controlled Substance Schedules (usdoj.gov)
Examples include: hydromorphone (Dilaudid®), methadone (Dolophine®), meperidine (Demerol®), oxycodone (OxyContin®, Percocet®), and fentanyl (Sublimaze®, Duragesic®), morphine, opium, codeine, hydrocodone, amphetamine (Dexedrine®, Adderall®), methamphetamine (Desoxyn®), methylphenidate (Ritalin®), amobarbital, glutethimide, pentobarbital, (Tylenol with Codeine®), buprenorphine (Suboxone®), benzphetamine (Didrex®), phendimetrazine, ketamine, anabolic steroids such as Depo®-Testosterone, alprazolam (Xanax®), carisoprodol (Soma®), clonazepam (Klonopin®), clorazepate (Tranxene®), diazepam (Valium®), lorazepam (Ativan®), midazolam (Versed®), temazepam (Restoril®), and triazolam (Halcion®), (Robitussin AC®, Phenergan with Codeine®), and ezogabine.
Emergency, urgent and non-urgent concerns:
In the event of an emergency (you feel suicidal, homicidal, or medical emergency), call 911 or go to the closest emergency room.
If you have a need for consultation outside of an appointment (medication side effects, increase in symptoms, etc.), please direct your questions to me via the email or phone number listed. Mindful Therapy Group administrative staff is not clinically trained and are unable to support with these pieces.
I am available for patients on Mondays, Tuesdays, Wednesdays and Thursdays from 7:00am PST to 2:00PM PST so please be aware that I may not be able to respond to you until I am in office, before, between and after patient appointments. For after hours, weekends, or if you need help immediately you should call the crisis clinic 1.866.4CRISIS (1.866.437.4747). In private practice, I do not have on-call coverage for emergent situations or have assisting prescribers to support with emergent needs.
Occasionally questions arise in-between our visits. If you have a question or concern related to your treatment and need to communicate with me between appointments please contact me via email. I will aim to respond within 72 hours. I work set days Monday, Tuesday, Wednesday and Thursday. I will not be available for emergencies (those which are threatening to life or limb).
Examples of emergencies include: having an active intent to end your life, to harm someone else, having auditory hallucinations instructing you to do things, manic symptoms such as impulsivity and high-risk behavior, or an allergic reaction to medication involving swelling in the lips, mouth or throat. In an emergency such as these please go directly to the nearest emergency department, or contact emergency services to take you to the nearest emergency department. I need to know about these circumstances also, but I am not available to treat these issues outside of our appointment times. For urgent issues which cannot wait until our next scheduled appointment, please leave a detailed message on my secure voice-mail or email.
Examples of urgent issues include: having intolerable side-effects to medication, needing to taper a medication I provide to you which you’ve been advised to stop using by another of your health-care providers, having run out of medication between visits due to loss, theft or misplacement.
Please note: Most clinical issues should be shared in our session.
New Patients:
There will be 1-2 initial visits to ensure proper assessment and thorough evaluation. I will NOT typically prescribe medication on the first visit. The first appointment (s) are up to 90 minutes, and subsequent appointments will range from 30-60 minutes depending on each person’s needs and preferences. These appointments will be used to evaluate, educate and determine a mental health diagnosis, as well as discuss side effects and efficacy of your prescribed medication. I may want to see you weekly-biweekly until either your symptoms are alleviated, or your condition is improving. We will work together to determine the best frequency of appointments going forward based on your health, treatment goals and stability of your condition. For stable patients, I need to you at least every three months in order to continue safe and effective management of your medications.
Psychotherapy: As individual’s circumstances and needs evolve, I incorporate components of psychotherapy as appropriate depending on the current problems. These modalities include behavioral activation, cognitive behavioral therapy (CBT), general psychiatric management (GPM), interpersonal psychotherapy, motivational interviewing, psycho-education and supportive psychotherapy.
Scheduling Appointments: Please contact our front office staff for all scheduling needs, as I am not in the office every day to ensure prompt attention.
Refill Policy: Medication prescriptions should be requested during our sessions together. This allows us to discuss how the medications are working and how long you should take them. Very occasionally, you may need a refill between sessions. Please call your pharmacy as soon as possible if this should happen to you. Keep an eye on your dosage amount to avoid a rush, and to give the pharmacy and myself enough time to get your refill processed.
Please allow 5 BUSINESS DAYS for medications requested outside of our appointments. I will not authorize refills if you have no future appointment, since I am legally required to ensure that you are in active treatment if I am prescribing medications.
Please note that in the event of a missed, rescheduled, or cancelled appointment, your medications may not be refilled. If there is a pattern of repeated cancellations and refill requests over the phone, this will be addressed, and a service charge of $30 for phone refill requests will be charged for each occurrence.
I am unable to provide refills of medications provided by other providers or for other medical conditions, including narcotic pain medication and I am not required to prescribe any medications on your first visit.
If you are traveling out of WA State, please be aware that ARNP prescribing laws vary between states and you may or may not be able to fill medications outside of WA. Please contact the pharmacy you intend to use while out of state for more information prior to traveling.
FMLA, disability and other paperwork requests: Occasionally patients encounter circumstances in which they find themselves with impairment in their ability to function adequately to meet the requirements of their work. At times it may be appropriate to use FMLA or disability to provide support until the functioning has returned. I do not complete this paperwork for new patients, whom I do not have an established therapeutic relationship with. For individuals requesting this type of assistance, I require that we meet to discuss the specific functional impairments. Please allow 5 business days for completion of this documentation.
Cancellation Policy: In order to provide you with optimal care, your appointment time is reserved for you. I do not double book clients. In return, I ask that you provide our front office with a minimum of 24 hour notice if you are unable to make it to your appointment. Please call our front office staff for all scheduling needs at (206) 453-5707 to ensure prompt attention.
Confidentiality:
Information discussed during the course of treatment is confidential. By law, information concerning your treatment may be released only with your consent (or that of your guardian if applicable). In the event where there is suspected child abuse, neglect, exploitation (RCW 26.44) or an imminent danger of harm to one's self or others, the law requires the release of confidential information. In these instances, we are required to make a report to the appropriate authorities. In addition, the courts may subpoena treatment records in certain circumstances. Any type of release of confidential information will be discussed with you. We are compliant with the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights with regard to personal health care information (PHI). HIPAA requires that we provide you with a Notice of Privacy Practices. This Notice, which is attached to this agreement, explains HIPAA in detail and its application to your personal health care information.