Forest Path Psychiatry & Healing

Effective Date: October 1st, 2024

TABLE OF CONTENTS

I. Service Agreement

   A. Scope of Services

   B. Eligibility Requirements

   C. Telehealth Platform

   D. Service Limitations

II. Appointment Policies

   A. Scheduling

   B. Cancellation and No-Show

   C. Late Arrival

   D. Emergency Coverage

III. Financial Policies

   A. Payment Terms

   B. Insurance

   C. Cancellation Fees

   D. Additional Services

IV. Medication Management

   A. Prescribing Policies

   B. Controlled Substances

   C. Refill Procedures

   D. Pharmacy Communication

V. Communication Policies

   A. Secure Messaging

   B. Response Times

   C. Emergency Contact

   D. Technical Requirements

SERVICE AGREEMENT

A. Scope of Services

Forest Path Psychiatry & Healing provides telepsychiatry services including:

- Psychiatric evaluation and diagnosis

- Medication management

- Treatment planning

- Care coordination

- Crisis assessment and planning

- Documentation and care summaries

All services are provided via secure telehealth platform to Colorado residents only.

B. Eligibility Requirements

To receive services, you must:

1. Be a Colorado resident

2. Have a device with video and audio capability

3. Have reliable internet access

4. Be physically located in Colorado during sessions

5. Have capacity to consent to treatment

6. Provide accurate identification and insurance information

7. Complete all required intake documentation

8. Maintain emergency contact information

C. Telehealth Platform

1. Platform Requirements:

- Services delivered exclusively through TherapyNotes

- Video and audio capabilities required

- Secure internet connection required

- Private location required for sessions

- Mobile device or computer with updated browser

2. Technical Support:

- Basic troubleshooting provided

- Platform-specific support through TherapyNotes

- Backup phone system for technical failures

D. Service Limitations

Our services are NOT appropriate for:

- Psychiatric emergencies

- Acute suicidal ideation requiring immediate intervention

- Severe substance withdrawal

- Medical emergencies

- Court-ordered evaluations

- Disability determinations

- Complex forensic matters

APPOINTMENT POLICIES

A. Scheduling

1. Session Types and Duration:

- Initial Evaluation: 60 minutes

- Medication Management: 15-30 minutes

- Follow-up visits: 30 minutes

2. Scheduling Process:

- Online scheduling through patient portal

- Minimum 24-hour notice required

- Confirmation required

- Insurance verification required

B. Cancellation and No-Show

1. Cancellation Policy:

- 24-hour notice required

- Late cancellations charged at 50% of session fee

- Emergencies considered on case-by-case basis

2. No-Show Policy:

- Full session fee charged

- Three no-shows may result in termination

- Insurance does not cover missed sessions

C. Late Arrival

1. Late Policy:

- Sessions end at scheduled time

- Full fee applies regardless of arrival time

- 15+ minutes late may require rescheduling

2. Provider Delays:

- Notification provided when possible

- Full session time honored

- Rescheduling option if preferred

D. Emergency Coverage

1. After Hours:

- Crisis line information provided

- Local emergency services available

- On-call provider not available

- Emergency resources listed on website

2. Crisis Planning:

- Crisis plan required for all patients

- Local emergency contacts identified

- Resources provided in advance

- Protocol reviewed regularly

FINANCIAL POLICIES

A. Payment Terms

1. Payment Methods:

- Credit/debit cards required on file

- HSA/FSA cards accepted

- No cash or checks

- Payment due at time of service

2. Fee Schedule:

- Initial Evaluation: [Amount]

- Medication Management: [Amount]

- Follow-up visits: [Amount]

- Additional services billed at [Amount]/hour

B. Insurance

1. Participating Insurance:

- Verification required before first visit

- Copays due at time of service

- Deductibles patient responsibility

- Benefits explained before treatment

2. Non-Participating Insurance:

- Payment due at time of service

- Superbill provided for submission

- No guarantee of reimbursement

C. Cancellation Fees

1. Standard Fees:

- Late cancellation: 50% of session fee

- No-show: 100% of session fee

- Insurance does not cover

2. Exceptions:

- Medical emergencies with documentation

- Severe weather conditions

- Technical failures on provider side

- Other circumstances at provider discretion

D. Additional Services

Fees apply for:

- Documentation requests

- Letter writing

- Form completion

- Care coordination

- Legal proceedings

- After-hours services

MEDICATION MANAGEMENT

A. Prescribing Policies

1. General Guidelines:

- Evidence-based prescribing

- Regular medication reviews

- Side effect monitoring

- Therapeutic drug monitoring

- Generic preferences

2. Requirements:

- Accurate medication history

- Regular follow-up compliance

- Reporting of side effects

- Pharmacy designation

- Adherence monitoring

B. Controlled Substances

1. Prescribing Limitations:

- Colorado law compliance

- DEA regulations

- PDMP monitoring

- Quantity restrictions

- Refill policies

2. Requirements:

- Initial in-person visit may be required

- Regular follow-up compliance

- Urine drug screening

- Pharmacy lock-in

- Treatment agreement

C. Refill Procedures

1. Standard Medications:

- 72-hour notice required

- Portal requests preferred

- Pharmacy communication

- Insurance authorization

2. Controlled Substances:

- No early refills

- No replacement prescriptions

- Follow-up compliance required

- PDMP verification

D. Pharmacy Communication

1. Preferred Pharmacy:

- Designation required

- Updates as needed

- Direct communication

- Electronic prescribing

2. Issues Resolution:

- Insurance problems

- Stock verification

- Prior authorizations

- Cost concerns

COMMUNICATION POLICIES

A. Secure Messaging

1. Appropriate Use:

- Non-urgent questions

- Prescription requests

- Appointment scheduling

- Documentation requests

2. Response Expectations:

- 1-2 business days

- Not for emergencies

- Clinical questions limited

- Brief responses only

B. Response Times

1. Standard Communications:

- Portal messages: 1-2 business days

- Prescription refills: 72 hours

- Forms/letters: 5-7 business days

- Records requests: 30 days

2. Urgent Matters:

- Same-day response during business hours

- Emergency services for immediate needs

- Crisis line available 24/7

- Local resources provided

C. Emergency Contact

1. During Business Hours:

- Call office directly

- Portal message for non-urgent

- Emergency services if immediate

- Crisis line available

2. After Hours:

- Emergency services (911)

- Crisis line

- Local emergency room

- On-call provider not available

D. Technical Requirements

1. Minimum Standards:

- High-speed internet

- Updated device/browser

- Video/audio capability

- Private location

- Backup phone access

2. Troubleshooting:

- Basic support provided

- Platform-specific help

- Alternative plans for failure

- Session rescheduling if needed

MEDICATION MANAGEMENT

By accessing and using our services, you acknowledge that you have read, understood, and agree to these Terms and Conditions. These terms are subject to change, and updates will be provided through our patient portal.

Effective Date: October 1st, 2024

Last Updated: October 1st, 2024

Forest Path Psychiatry & Healing

2020 N Academy Blvd

Ste 261 #2016

Colorado Springs, Colorado 80909

Phone: (719) 301-1232

Fax: (888) 520-6144

Website: www.ForestPathPsychiatry.com

END OF TERMS AND CONDITIONS