POLICIES

CONTROLLED SUBSTANCES

Medications such as benzodiazepines and stimulants are tightly regulated by the DEA. These medications can be very useful when indicated but require more frequent monitoring and must be part of a comprehensive treatment plan. This treatment plan may include a referral with a therapist to help develop effective coping mechanisms associated with mental health issues that require a prescription for a benzodiazepine.  Controlled substances will not be refilled early and cannot be refilled without an appointment. At my discretion, a urinary drug screen may be utilized to determine compliance with our initial agreement on the controlled substance being prescribed.

This practice utilizes the Iowa Prescription Monitoring Program (PMP), a statewide database that allows providers to see the history of controlled substances prescribed to an individual. This initiative was designed to limit the abuse and diversion of certain medications, by informing providers about current and past prescriptions and helping them prescribe medication more safely and effectively.

 

MEDICATION AND REFILL POLICY

In order to ensure treatment quality and safety, all prescriptions should be requested and refilled during your appointments.  This allows me to monitor efficacy, assess for potential side effects or complications, and discuss any concerns you might have. The subsequent follow-up appointment is always scheduled at the end of an appointment and prescriptions are provided with enough refills to last until your next scheduled appointment. If you cancel or miss an appointment and run low or out of medications without rescheduling in a timely manner, your refill request may be charged my standard fee of $30 per occurrence.

 

If extenuating circumstances require that you need a refill between appointments, please:

 

  • First, check your prescription bottle for any remaining refills. If your current prescription has no remaining refills, please call your pharmacy, as there may be a new prescription on file that has not yet been filled. 

  • If there are no remaining refills and no new prescriptions on file, please leave me a voicemail with the following information: your name, the name/dosage of the medication being requested, and the name and phone number of your pharmacy. I do not respond to faxed pharmacy refill requests without also receiving a verbal or written request from the client or their legal guardian, as these faxes are often automatically generated and sent without the patient’s knowledge.

  • Please allow 3 business days to process this request while keeping in mind that refill delays may occur due to issues with insurance authorization or pharmacy stock. It is your responsibility to monitor your supply to avoid running out of medication.

 

PLEASE NOTE:

I am not able to provide prescriptions for new medications between appointments, as these treatment changes require clinical assessment and further discussion.

  • I am not able to refill any medications written by other providers for conditions I am not treating.

  • To fulfill your refill request, you must have a future appointment scheduled with me.

  • I do not monitor refill requests over the weekend of after hours.

  • I do not provide refills of medications designated as controlled substances outside of appointments.

 

CANCELLATION, LATENESS, AND NO-SHOW POLICY

I require a minimum of 48 hours’ notice when canceling or rescheduling an appointment in order to avoid a late cancellation fee. Please contact the office at 563.538.0550 to cancel or reschedule appointments. Missed appointments or appointments canceled or rescheduled with less than 48 hours’ notice will incur the following fees, which are not covered by insurance and will be charged to your credit card on file:

 

  • Basic follow-up appointments (20 minutes): $120

  • Extended follow-up appointments (50 minutes): $175

  • If you are more than 10 minutes late to a scheduled appointment, your appointment may be canceled and charged the above-missed appointment fee.

LEGAL SERVICES

Please note that I do not provide court evaluations or court testimony, and this is not a Forensic Psychiatry office. If I am ordered to testify in proceedings, it seriously undermines my therapeutic practitioner-patient relationship, is very disruptive to the office routine, and is unfair to my other patients. Please inform me immediately if you are involved in, or plan to go to court. I accept clients only with the specific agreement that they will not involve, A Beautiful Mind, INC., or Earlene M. Angell PMHNP-BC in any legal matters, including but not limited to child custody, workers’ compensation claims, and criminal cases. We do not provide legal opinions, do evaluations, or testify for disability or child custody cases.

 

CLIENT RIGHTS AND CONFIDENTIALITY

In compliance with the Health Insurance Portability and Accountability Act (HIPAA), I maintain a confidential clinical record of your treatment information, which is considered Protected Health Information (PHI). Your clinical record includes your reasons for seeking treatment, your psychiatric and medical history, any psychiatric diagnoses, your treatment goals, our treatment plan, your clinical progress based upon my assessments, your billing records, and any records you provide to me from other treatment providers.  You have the right to ask questions and provide honest feedback about your treatment, as well as review and correct any information in your record at any time.  Requests to review records will be granted within 14 business days.  All treatment information, including your record and any content discussed during sessions, is confidential.  Treatment information may only be released upon the written or verbal consent of the patient or patient’s legal guardian, if applicable. If you authorize the disclosure of information, you have the right to ask that I limit the information shared, except in cases that require a breach of confidentiality by Iowa State law.  Circumstances that require a breach of confidentiality include: 

  • Suspected abuse of a child, dependent adult, or vulnerable person

  • If I believe there is a clear and imminent risk of harm to yourself or others, including situations of suicidal behavior or threatened harm to another individual 

  • When legally required by a court order 

  • During medical and psychiatric emergencies

  • When required by your insurance company for billing and payment operations. This information includes appointment dates, diagnosis codes, services rendered, and any other additional clinical information that the insurance company may request. 

 

If you feel that your patient rights have been violated, you have the right to report any concerns or complaints to the  U.S. Department of Health & Human Services at 1-800-368-1019 or https://www.hhs.gov/hipaa/filing-a-complaint/index.html

AVAILABILITY AND COMMUNICATION

The structure of my practice limits the scope and complexity of clinical services that I can provide in the outpatient private practice setting.  I am not able to provide on-call or crisis management services and am not available outside of my normal business hours.  If more intensive services are required or recommended, I can provide referrals to a better-suited practice or treatment setting.  Most clinical issues should be discussed and shared during our appointments.  However, issues that may need to be addressed between appointments include unexpected medication side effects and adverse reactions. I make every effort to respond to messages promptly, but please note that most of my practice hours are spent meeting with clients, and therefore, it may take 48 business hours for me to respond to messages.   

Onpatient Portal: I ask that clients communicate via my secure patient portal, Onpatient. This ensures confidentiality and continuity of your records and allows for more direct communication and faster response times. You can log in to the portal by visiting Onpatient.com. Onpatient can also be accessed through their free smartphone app. If you need another invitation email sent, are unable to login, or have questions about using the portal, contact the office via phone or email. 

Email: Please be aware that emails are not HIPAA-secure, and therefore, I cannot guarantee the security of any information communicated via email.   

EMERGENCIES

In the event of an emergency (medical emergency, or suicidal or homicidal thoughts or behaviors) please call 911 or go to the closest Emergency Room. 

Urgent Consultation: I am not able to provide non-urgent consultations or check-ins between scheduled appointments. If you have an urgent need for consultation during business hours but are not experiencing an emergency or crisis, please call my office at 563.599.6991 and send a secure message via the onpatient portal.  Consultations between appointments are handled on a case-by-case basis and are conducted via telephone or telemedicine, which may be subject to a fee not covered by your insurance. 

 

After Hours Resources: If you have an urgent concern after hours or on a weekend/holiday, please call the local crisis clinic at 563.589.7870 or go to the nearest Emergency Department.  If you have a non-emergent concern about a potential medication side effect or adverse reaction, you may also contact your pharmacist for consultation. Please note that these support resources are not a safe substitute for seeking emergency care for medical or psychiatric emergencies, including suicidal or homicidal thoughts or behaviors. Additional crisis support resources include: 

  • In the event of a psychiatric emergency please go to your local Emergency Department for assistance or call 911.

  • National Suicide Prevention Lifeline: 1-800-273-8255.

 

TERMINATION OF CARE

​You have the right to terminate care at any time, for any reason.  Upon termination, I will make every reasonable effort to make appropriate referrals for continued care. I reserve the right to terminate our treatment relationship under the following conditions: ​

  • If I believe that my services are no longer beneficial to you. 

  • If I believe that you would be better served by a higher level of care or by a different provider.

  • If I suspect prescription medication abuse or undisclosed substance abuse. 

  • If there is a pattern of frequent cancellations/no-shows

  • If you cancel or miss an appointment and do not reschedule within 30 days of the missed appointment or notify me that you wish to continue care if extenuating circumstances prevent you from rescheduling within 30 days of the missed appointment.  

  • If I deem interpersonal dynamics are not conducive to a therapeutic relationship or if you or a family member are hostile or aggressive to either my support staff or myself. 

In the event of a psychiatric emergency please go to your local Emergency Department for assistance or call 911. Iowa Crisis Line; Call, text, or Chat, at 855.800.1239 or Visit https://www.iowacrisischat.org

National Suicide Prevention Lifeline: 1-800-273-8255.