* If this is an emergency, please call 9-1-1 *

**PLEASE READ THE FOLLOWING AND REGISTER AS A NEW PATIENT.**

The policies and procedures include but not limited to: 

1. No-Show / Cancellation Appointments 
2. Records
3. Telehealth/Telemedicine 
4. Medication Management 
5. Phone Calls * COVID Protocol

1. Appointments

• No-shows and cancellations with less than 48-hour notice are significant problems for our practice. Many practices overbook on purpose so that no-shows and cancellations won’t limit access of other patients as well as cause a financial hardship for the practice.
• No shows become even more burdensome when the appointment is for a new patient/client appointment. This is due to the extra time set aside for new patients/clients. It is also detrimental to other new patients/clients who could have been seen during that time.
• We request that you maintain the scheduled time. If unable, we require you please notify the office 48-hour in advance to reschedule or cancel so we may better accommodate other patients/clients. Any cancellation within the 24-hour window is considered a late cancellation.
• Our appointment system also sends a courtesy several reminder notifications prior to all appointments.
  • Please do not rely solely on appointment reminder calls, as this is only a courtesy.
• Failure to show up for an appointment and/or cancel less than 48 hours in advance will result in a late cancellation or No-Show fee as follows:
• First (2) two no-shows and late cancellations within a 12-month period, patient/client is charged a fee of $75.00 for each missed appointment or late cancellation.
• Third missed appointment within a 12-month period, patient/client (not insurance) will be charged the full session fee as follows:
• Psychiatric Initial evaluation – $375
• Psychiatric Follow-up – $175
• Psychotherapy Initial evaluation – $200
• Psychotherapy follow-up – $150
• Discharge letter from the practice.

2. Records

Routine school or work excuses are available upon request at the end of your appointment. Upon receipt of your request, records can be pulled and upload to the Patient Portal.

Please allow 3-5 business days to complete.

If time permits, brief forms (“simple” – less than 5 minutes, i.e., absentee note, accommodation letter) may be completed during your allotted appointment time and there will be no additional charge — notify the front desk at the beginning of the appointment if any of these forms are required.

Longer forms and letters will be done outside of appointment time and the feewill be based on time required to complete the request as follows:

• Simple (less than 5 minutes) No Charge
• Moderate (5-15 minutes) $50.00
• Lengthy (15-30 minutes) $100.00
• Complex (over 30-60minutes) $200.00
• Special Complex Request (over 60 minutes) $200.00/Hour
• If records have be printed, faxed, or mail, a fee of $25 for the first 20 pages and $0.50 for each additional page.

3. Telehealth

Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. Telemedicine is sometimes used as a synonym or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. A telehealth appointment can be made via the Patient Portal.

Preparing for Telehealth Appointment

DO’s

• You will receive a Telemedicine GoToMeeting Provider link the day prior to your scheduled appointment. (If you do not, please contact the office immediately to have that link resent).
• Link can also be found here under your provider’s profile.
• Use the latest version of Google Chrome.
• Ensure you have a good connection, and your device is fully charged and check your audio and video.
• Patients with poor connection will be rescheduled
• Choose a well-lit, private, confidential space for Telehealth sessions.
• Ensure no one else is within hearing range.
• Prepare a list of questions and have prescriptions and supplements on hand.
• Please log in 5 min prior to appointment.
• Patient will be considered a “no-Show” 10 min past appointment and a no-show fee will be assessed.

DON’Ts

• For safety reasons, no telemedicine session will be conducted with patient/client in a moving vehicle, either as a patient or client.
• Failure to comply with the above will result in your appointment being cancelled and a No-Show fee will be added.
• No unauthorized person(s) is allowed during your session.
• No minors will be allowed to attend Telemedicine session unsupervised. A legal guardian or an adult must be online and available for all sessions.

Safety & Privacy Telehealth visits will be terminated immediately if patient/client is in a moving vehicle either as driver or passenger and/or with an unscheduled or unauthorized participant.

4. Medication

Medication Management Services are a spectrum of patient-centered, pharmacist provided, collaborative services that focus on medication appropriateness, effectiveness, safety, and adherence with the goal of improving health outcomes. It is a service that is individualized for a specific patient, focusing on the patient’s needs and concerns, which also involves the patient in the care process.

• All refill requests must be submitted through your Patient Portal.
• Calls of faxes prescription refills will NOT be accepted nor processed
• Providers give enough refills to make it to your next scheduled appointment. If you have missed or canceled your appointment, you will need to book an appointment. a partial refill of the requested medication may be given until that upcoming appointment at the doctor’s discretion
• Please allow 3 business days to process the refill request. Refills after 3:00 pm will be reviewed the next business day
• The practice reserves the right to deny any refill requests if provider suspects abuse or patients are not taking the medication as prescribed
• First psychiatric follow-up (FU) visits will be scheduled for next two (2) weeks or next available after initial appointment
• Refill may not be provided if patients have not been seen for three (3) months
• Medications will not be changed or adjusted without an appointment
• Refills will NOT be given to patients who no-show for a follow-up appointment
• Patients on controlled substances, will NOT be provided refills or bridge prescriptions until they are seen.
• A bridge prescription can be prescribed until the next available appointment
• Parents must be present during appointments for all patients under 18 years old
• Benzos will be limited to 6 weeks or less
• Patients with sedative dependence should be tapered off the drug or offered referral to inpatient treatment
• Sleeping pills (Z drugs) will be limited to 20 days a month
• Stimulants and sedatives will be limited to one stimulant or one sedative, not both
• One dose of long-acting stimulant is preferable to instant release stimulants or a long-acting dose plus an instant release
• We recommend to not wait until the last minute.

5. Scheduled Phone Calls

Please note that if you call is of an emergency, please call 911 or go to the nearest emergency room.

Our providers are not often available during the day as they are in session with patients/clients. If you need to see a provider between appointments, please send your request via our Patient Clinical Request Form or the Patient Portal with the nature of the call. Providers will respond to messages as soon as availably possible. Based on the outcome of call, you may be asked to schedule an earlier follow up appointment. Calls or extended telephone consultations during office hours that otherwise would have necessitated an office visit are charged at a rate of $25.00/5 minutes with a minimum charge of $25.00.

If you are in agreement, please proceed to register in our HIPAA-compliant patient portal, which provides convenient 24/7 access to your healthcare information, access to your provider, medication refills, schedule appointments, view, and pay bills.

• Be sure to upload or e-mail copies of your state-issued ID AND insurance card (front and back) to info@impireum.com.
• Upon completion, you will receive an e-mail notification to complete the registration process.
• Please schedule as a NEW patient if you have never been seen in the clinic.
• Not all providers see all ages, please double-check that the provider you are scheduling with sees your age group.
• Patients/Clients are discouraged from switching between providers or booking with another provider without prior notice to Impireum.
• Do not hesitate to contact our office at (877) 631-0010; ext 1 or e-mail at info@impireum.com with any questions.