Clinic Policies and Procedures
These are the office policies and procedures that are important to your care. Please review the policies below thoroughly prior to your visitation or early within the course of your treatment. If there are any confusion, don’t hesitate to ask for clarification.
Please take note that some of the below rules are described in simple and concise terms in the Question and Answer section of this website.
Privacy and Release of Information
Our practice values and upholds the importance of your confidentiality. In addition to your rights as a patient, our practice has duties to protect your confidential information and inform you of changes to protection measures. We are required by law to maintain the privacy of confidential information and provide you with notice of our legal duties and privacy practices with respect to such information. We are required to abide by the terms of this Notice currently in effect.
There are, however, certain situations in which we must, by law, communicate your confidential information. Here are a list of those circumstances:
- We have reason to believe you are a danger to yourself or another person or persons
- We become aware of abuse to child, elder or developmentally disabled person
- We are under court order to release information
- Subpoena of treatment records by an attorney. (We will not immediately release records upon receipt of a subpoena, but will do anything in our power to keep your records private. Usually a court order will be required. You have up to fourteen (14) days to obtain a protective order from the court to avoid disclosure of your records)
- If you are applying for your health insurance benefits, we may be required to provide information to your health plan, including some or all of your patient chart, in order for them to approve payment.
- If you are party to child custody litigation at any time in the future, the court may order release of information about your treatment here.
- In some instances, as provided by the state law of Texas, information about your healthcare may be exchanged with other healthcare professionals involved in your treatment.
Disclosure and Confidentiality
Confidential information may be released for payment and healthcare operations only to health insurance plans and their agents, as well as business associates of the practice. The definition of a health insurance plan does not include life insurance companies, automobile insurance companies, or workers’ compensation carriers. These are not covered under HIPAA. If you would like information submitted to one of these companies, an authorization will be required, unless it is already mandated by state or federal law.
The following routine situations necessitate the use of your information:
- For Treatment - We may use information about you in order to provide you with proper medical treatment or services. Treatment is when we provide, coordinate, or manage your healthcare and other services related to your healthcare. An example of treatment is when we consult with another healthcare provider, such as your primary care physician.
- For Payment - We may use and disclose information about you so that the treatment and services you receive can be collected from an insurance company, or a third party (including a collection agency if necessary). For example, we may give your health insurance plan information about services you received at the practice, so your health insurance can reimburse you for the services. We may also tell your health insurance plan about a treatment you are going to receive, in order to obtain prior approval or determine if your plan will cover the treatment.
- For Healthcare Operations - We may use and share information about you for administrative functions necessary to run the practice and promote quality care. We may share information with business associates who provide services necessary to run the practice, such as transcription companies or billing services. We will contractually bind these third parties to protect your information as we would. Also, we may permit your health insurance plan or other providers to review records that contain information about you to assist them in improving the quality of service provided to you.
- Communicating with You and Others Involved in Your Care - This practice may contact you to provide appointment reminders, information about treatment alternatives, or other health-related benefits and services that may be of interest to you. In certain situations, we may share information about you with a friend or family member who is involved in your care or payment for your care unless you have requested that such disclosures not occur. Overall, it is our mission to honor confidentiality of our patients with utmost regard. Information disclosed will be directly relevant to such person’s involvement with your care or payment related to your care. Whenever possible, this person will be identified by you. However, in emergencies or other situations in which you are unable to indicate your preference, we may need to share information about you with other individuals or organizations to coordinate your care or notify your family.
Special Circumstances in Release of Private Information
The following special circumstances necessitate the use of your information:
- As Required By Law - We will disclose information about you when required to do so by federal, state or local law. For example, we may release information about you in response to a valid court subpoena.
- Health Oversight Activities - We may disclose information to a health oversight agency for activities authorized by law. For example, these oversight activities include: audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the healthcare system, government programs, and compliance with civil rights laws.
- For Judicial or Administrative Proceedings - If you are involved in a court proceeding, and a request is made for information about the professional services that you have received within our practice and the records thereof, such information may be privileged under state law. We will not release information without the written authorization of you or your legal representative, or in instance of issuance. This may also be the case in the instance of a court subpoena, which requires the provision of such information, which you have been properly notified. In response, you have not opposed the court subpoena within the legally specified format and time frame, or in the instance of the issuance of a court order compelling us to provide Protected Health Information (PHI). This privilege does not apply when you are being evaluated for a third party or where the evaluation is court-ordered. You will be informed in advance if this is the case.
- To Avert Serious Threat to Health or Safety - We may disclose your confidential mental health information to any person without authorization if we reasonably believe that disclosure will avoid or minimize imminent danger to your health or safety, or the health or safety of any other individual. These disclosures may be to law enforcement officials to respond to a violent crime or to protect the target of a violent crime. For example, threats of harming another individual may be reported to appropriate authorities.
- Worker’s Compensation - If you file a worker's compensation claim with certain exceptions, we must make available at any stage of the proceedings, all PHI information in our possession that is relevant to that particular injury in the opinion of the Texas Department of Labor and Industries, to your employer, your representative, and the Department of Labor and Industries upon request.
- Public Health Risks - We may disclose information about you for public health activities. These activities generally include, but are not limited to, the following:
a. To prevent or control disease, injury, or disability
b. To report child abuse or neglect
c. To report adult and domestic abuse
d. To report reactions to medications or problems with products
e. To notify people of recalls of products they may be using
f. To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition
g. To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.
- Law Enforcement - We may release information about you if asked to do so by a law enforcement official:
a. In response to a court order, subpoena, warrant, summons, or similar process
b. To identify or locate a suspect, fugitive, material witness, or missing person
c. If you are suspected to be a victim of a crime, generally with your permission
d. About a death we believe may be the result of criminal conduct
e. About criminal conduct at the hospital
f. In emergency circumstances involving a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime
HIPPA Protected Collaboration: HIPPA protects collaboration of physician/advanced nurse practitioner to other physician/advance nurse practitioner individually or via phone if pertaining to important aspects of your care. Such physician to physician collaboration is HIPPA protected.
Other uses and disclosures of information not covered by this notice or the laws that apply to our practice will be made only with your written permission. If you provide this practice with specific permission to use or disclose information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures that have already been made with your permission and that we are required to retain our records of the care that we provided to you.
Changes to Notices
We reserve the right to revise or change provisions on this notice and our general policies. We will make the new notice provisions effective for all confidential information we maintain. Our clinic will promptly revise and distribute notice whenever there is a change to the uses or disclosures, your rights, and our duties, or other privacy practices stated in this notice. We will mail updates of our notice to all active patients. Patients who are inactive at the time of mailing may receive an updated copy at their next scheduled appointment.
An electronic record is kept of services you receive in this office. You have a right to see the record and receive a copy of it upon request. You may ask that factual errors in the record be corrected. You may authorize in writing that copies of the record be released to entities you designate, at your expense, according to charges stipulated by the state law of Texas. Under certain circumstances where seeing the record may put a patient or other person at risk, we may redact certain information in the record and/or require that you review the record in consultation with another healthcare provider. You may receive an accounting of non-routine uses and disclosures of your record. Please note that there is a $25 charge for obtaining record to compensate staff time, printing, and sending of document.
If you are requesting a document to be filled by our clinic, including letter, FMLA, Disability, or Employment forms, please notify us at least 10 days prior to your desired submission date. We try to complete forms as soon as possible but please be aware that due to patient load and patient care related responsibilities, clinic requires fair advanced notice. Please note that there are fees per document requested that are specified in Payment Information.
Concerns for Safety
If as a patient, you are deemed a safety concern for self and/or others or are assessed during evaluation to have declined physically and emotionally to the point that self-care is an issue, it is our legal obligation to inform mental health deputies or officials for further action which may include detainment or acute psychiatric hospitalization. In such events as noted above, your confidentiality and your records will be released to officials and the aftercare facility.
Policies Regarding Usage of Controlled Substances
As a clinic, we aim to treat our patients with regard to potential harmful or addictive side effects of medications. As a rule, we attempt to avoid first line prescription of highly addictive medications such as hypnotics, benzodiazepines, or stimulant medications. However, in events that patient's condition warrants such usage, accurate and appropriate usage of these medications is necessary in continued treatment. Noncompliance with medication regimen which include abuse or adjustment of dosage outside of prescribed guidelines warrant reconsideration of treatment with the controlled substance. If a patient presents from a previous treatment facility or physician with specific request to be continued or prescribed a controlled substance, we may see it as necessary to obtain records prior to agreement to prescribe the noted medication. If the patient has clear history of substance usage, we may abstain from any addictive option in treatment and if prescription of a controlled substance is seen as an option, only low dosage, transient treatment, or strict followup with urine drug testing may be deemed as therapeutic treatment. Failure to comply with such guidelines and overt abuse of controlled substances warrants termination of our therapeutic relationship.
Please note that patients maintained on Triplicate medications such as Stimulants (e.g. Adderall, Ritalin) and controlled, non-triplicate medications such as Benzodiazepines (Ativan, Xanax), Hypnotics (Ambien) and other potentially addictive medications, need very close follow-up and monitoring along with frequent follow-up. These scripts will only be given 30 day supply at a time. This is to comply with State and Professional regulations for usage of these medications and to avoid any misuse. For the first 6 months-1 year of therapy on these medications (based on doctor assessment), you may be asked to be seen monthly for each refill given. Once stable on symptoms, based on assessment of use, you will be allowed to follow-up every 6-12 wks. Under no circumstance can refills for schedule II triplicates and addictive benzodiazepine/sedative/hypnotics be filled outside of appointment time and in the event of misplaced, stolen, and lost scripts. If scripts are lost for any reason, they will ONLY be filled when it is due. EARLY REFILL OF ANY ADDICTIVE SCRIPT IS STRICTLY PROHIBITED UNDER CLINIC RULES.
It is our clinic policy that patients be given enough prescription to last them till follow-up visitation. In the event of unforeseen circumstance, we will be agreeable to refill for a transient duration of time until a follow-up is secured. It is our mission to minimize gaps in treatment of our patients that may render withdrawal and worsening of symptoms. If a patient has failed to followup for greater than 12 weeks and is an active patient, we will be unable to provide any further refills if patient is maintained on any controlled substance. If patient is a longterm stable patient who is not maintained on controlled substances, we may extend this followup further. In crises and certain circumstances, patients may discuss their concerns with management and exceptions with valid excuses may be honored.
If a patient is currently on a controlled substance such as benzodiazepine, hypnotic, or stimulant, they will be expected to followup every 4 weeks for an allotted duration of 6 months-1 year until stability is gained. In the case of triplicate orders such as stimulants, monthly followup may be warranted for an allotted duration of time. If a patient loses script for a controlled substance or requires a refill outside of scheduled time, WE WILL BE UNABLE TO FILL THE SCRIPT UNTIL APPROPRIATE DUE DATE. Under no circumstance can an early refill be allowed. Our clinic does not condone non-therapeutic usage of prescription medications.
Late Cancellations and Missed Appointments
Failure to keep your scheduled appointment may result in a fee of $100 for initial visits and $50 for follow-up visitation unless you cancel at least twenty-four (24) hours prior to the appointment time. In emergent circumstances, please immediately contact office and if the circumstance is determined to be dire, this fee will be waived. This fee cannot be waived more than twice.
Payment is expected prior to the initiation of your visitation with the psychiatrist. If you
are unable to pay your bill because of some financial hardship, please discuss
this with management to see if we can arrive at a mutually agreeable payment plan that
allows you to continue treatment. Seriously delinquent accounts may be referred
to a collections agency and may lead to termination of our relationship as doctor
Managed Care Policy
Our clinic has formally opted-out of managed care including Medicare and Medicaid. This means that as a clinic, we will establish a private contract with our patients under Medicare/Medicaid in agreement that services provided by our practitioner are not covered by Medicare and no payment can be made to the physician or practitioner or to beneficiaries. As a patient, you will be charged an agreed fee per clinic rules and you are responsible for full payment in cash to the clinic. This also means that reimbursement forms cannot be filed to Medicare by patient and the patient will not be able to receive any reimbursement. Patients under managed care will have to agree to signing a contract specifying the above terms prior to being seen by our psychiatrist. If you are not agreeable to such contract, we are unable to accommodate you as a patient.
Policy on Phone Calls
As a clinic, we see it within our duty to attend to any emergent or concerning situations. Basic questions regarding payment, insurance, and scheduling can be handled through our clinic director. All medical questions will be answered by one of our staff members after detail collaboration with our psychiatrist. However, if it becomes necessary to address your question directly with a psychiatrist, Dr. Rezaee will contact you directly via email or phone call. These phone calls are limited to 10 minutes. If there is no resolution in the duration of the 10 minutes allotted, then you can be booked for an emergent or crisis appointment and in the event of emergency, medical or psychiatric, you will be referred to care by emergency crew or officials. Any phone calls greater than 10 minutes are subject to fees, with every 15 minutes being charged for $50. If Dr. Rezaee has agreed that a followup phone call is necessary and this is considered essential in your treatment, then such fees may not apply. If in the midst of your call, any concerns for safety are noted, such as communication regarding suicidal ideation, then necessary steps will be taken to alert official authorities.
After Hour Policy
We are able to accommodate patients on individual basis for appointments after hours from Monday-Thursday from 5pm-7pm and One Saturday per month from 8am-1pm. You will need to discuss your special circumstance and we will attempt our best to schedule you for a time that would not hinder your work and home life. Please take note that the normal operations of our business continue to be Monday-Friday from 8am-5pm. This means that phone calls and emails along with administrative, and receptionist services are only attended to during these hours. If any concerns arise after hours that are non-emergent, you may call our office number and leave a message and we will attend to these as soon as possible during business hours. If, however, any emergent issues arise relating to your treatment or condition during after-hours, then please contact 911 or present to your nearest emergency center immediately. You may also contact our after-hour phone number for further crisis contact information to expedite and simplify your care.
If in the course of your treatment, concerning side effects arise, please contact us immediately. During your contact, alert our medical coordinator or clinic director regarding the specific symptoms. If side effects are minor, you will receive a followup call from one of our staff with further instructions. If, However, significant symptoms arise, Dr. Rezaee will contact you directly. If these symptoms arise after hours, then please present to your nearest emergency facility.
Right to Terminate Treatment
In certain rare circumstances, our clinic may reserve the right to terminate your treatment at Lakeway Psychiatry and Behavioral Health. We will immediately notify and discuss reasons and concerns leading to such action. In the event of misuse of prescriptions or in the case that your treatment is no longer seen as therapeutic, such that our options are maximized and further rapport and agreement in your care is compromised, then we may terminate our relationship. We will do our best to recommend further referrals. We also reserve the right to terminate your privileges as patient in the event of repeat nonpayment. We will do our best to accommodate any financial difficulties through payment plans if concerns are discussed with us. We also reserve the right to terminate treatment with repeat missed appointments.