At your initial appointment, we will discuss your past medical, psychiatric, family, and social histories, as well as the current problems that compel you to seek psychiatric treatment. Please use our time together to tell me your story, in your words. We will then collaboratively design a treatment plan to address your treatment goals. If we decide that your needs would be best served by another clinician, I will refer you to an appropriate level of care.

The length of treatment is highly variable. Remission of symptoms, decreased subjective distress, and increased biopsychosocial function are goals of psychiatric treatment, and Clinical Practice Guidelines for some psychiatric disorders suggest continuing medication treatment for 9-12 months after remission is achieved. In certain cases and for certain disorders, the suggested treatment is indefinite. Patients in the acute phase of treatment can expect to be seen every 2-3 weeks after starting a new medication and during titration/dose adjustments of medications, followed by monthly appointments during the continuation phase of treatment. To remain in the practice, medically stable patients must be seen quarterly during the maintenance phase of treatment.

The practice is in-network with some insurance companies, so costs of care should be covered after deductibles and co-pays are met. If the practice is not in-network with your insurance company, you might be able to request out-of-network benefits by submitting a “superbill” of services to your insurance company directly. Superbills are available on the patient portal.

For safety reasons, the practice does not prescribe benzodiazepines (Xanax, Klonopin, Ativan, Valium) or stimulants (Adderall, Ritalin).

Psychologists: Hold PhDs or PsyDs and are licensed to offer talk therapy and psychological testing to patients. Psychologists cannot prescribe medication.

Counselors: Hold advanced Social Work or Counseling degrees and are licensed to provide talk therapy to patients. Counselors cannot prescribe medication.

Psychiatrists: Hold MDs or DOs and are physicians with specialized training in the field of psychiatry. Psychiatrists have prescriptive authority. The medical model approaches disease states within a curative frame—psychiatrists identify and remedy pathology.

Psychiatric Nurse Practitioners: Registered Nurses with additional advanced specialized training in the field of psychiatry. Psychiatric Nurse Practitioners hold prescriptive authority. They assess, diagnose, and treat psychiatric disorders by combining psychotherapy and medication management, and they can diagnose underlying medical conditions that may contribute to or cause psychiatric symptoms. The nursing model approaches disease states within a healing frame—clinicians partner with patients to help them achieve recovery and wellness goals.

Acceptance into the Practice: Sean Murphy, PMHNPBC will collaboratively create an evidence-based treatment plan at the initial evaluation when a patient’s clinical presentation is appropriate for telepsychiatric care. If a patient’s treatment needs would be better served by in-person team-based care or if the patient does not agree with the diagnosis and proposed evidence-based treatment plan, the provider will suggest a referral to an appropriate level of care (another telepsychiatric provider, in-person care, team-based care, intensive outpatient program, partial hospitalization, or specialized care such as substance abuse evaluation and treatment or eating disorder treatment). Acceptance into the practice presupposes that the patient has provided to the clinician full, fair, and accurate medical, family, social, and psychiatric histories, including medication trials, current medications, hospitalizations, substance use, and legal involvement. Please note: As a solo practitioner in private practice, I am not equipped to manage patients with frequent decompensations/emergencies or those with serious mental illness diagnoses such as schizophrenia, borderline personality disorder, or co-occurring psychiatric and substance use disorders. If you have a history of cyclical decompensation or anticipate needing crisis services and/or hospitalization in the future because you have required them in the past, you will be better served by working with a large practice that can provide team-based care and comprehensive patient coverage.

Primary Care Provider: To ensure the safe provision of specialty psychiatric care from this practice, all patients are required to have a primary care provider. Additionally, your insurance company may require a referral from your primary care provider for psychiatric services.

Appointment Scheduling: The length of treatment is highly variable. Remission of symptoms, decreased subjective distress, and increased biopsychosocial function are goals of psychiatric treatment, and Clinical Practice Guidelines for some psychiatric disorders suggest continuing medication treatment for 9-12 months after remission is achieved. In certain cases and for certain disorders, the suggested treatment is indefinite. Patients in the acute phase of treatment can expect to be seen every 2-3 weeks after starting a new medication and during titration/dose adjustments of medications, followed by monthly appointments during the continuation phase of treatment. To remain in the practice, medically stable patients must be seen quarterly during the maintenance phase of treatment.

Cancellation and No-Show Policy: Please provide at least a 24-hour notice for cancellations. This policy helps patients access the care they need, when they need it. If you do not provide 24-hour notice, $150 will be charged to the form of payment on file with the practice. Insurance does not reimburse late-cancel and no-show fees.

Medication: Medications may be indicated when psychiatric symptoms are not responsive to psychotherapy alone and/or when a mental illness markedly impacts a patient’s ability to work, maintain interpersonal relationships, or properly care for their basic needs. During the initial appointment, the provider will discuss medication treatment options, potential side effects, and how to manage them. Not everyone is a good candidate for medication therapy. Such therapy requires strict adherence to dosage and frequency, adherence to keeping regular follow-up appointments, and sometimes the ability to present to labs for regular blood tests. Patients will not share prescribed medication with anyone else or receive psychiatric medications from other medical or medicinal providers without first informing Sean Murphy, PMHNPBC. Alcohol and other drugs of abuse will compromise treatment and make psychiatric symptoms worse. Your provider recommends that you abstain from these substances while in treatment. Additionally, combining alcohol or opiates with certain hypnotics or anxiolytics is particularly dangerous and can be fatal. If a patient misuses medications or combines them with other substances, they will likely be discharged from the practice and/or referred to a higher level of in-person care.

Controlled Substances and Prescription Refill Policy: The practice does not prescribe benzodiazepines such as Xanax, Klonopin, Ativan, or stimulants. Prescriptions for all other medications are written during appointments and cover the time between appointments only. Please be sure appointments are scheduled before prescriptions expire.

Payment Policy: All balances for professional services from Sean Murphy, PMHNPBC are charged to the authorized payment form (credit/debit/FSA or HSA card) on file with the practice. A refund for psychiatric services will only be considered in exceptional circumstances (e.g., clerical error in billing or provider inability to provide services due to unforeseen circumstances) and a refund must be requested within three days of the service date. No refunds will be issued for missed appointments, cancellations made less than 24 hours in advance, or for services already rendered. Please contact the practice manager to discuss any potential refund requests at 646-396-6105. The refund processing fee is 3.5% of the purchase. Payment in full is due at the time of service for self-pay and for insurance co-pay amounts. Self-pay rates are as follows:

• Initial Evaluation: $495

• Follow-Up Appointment Moderate Complexity 20 minutes: $240

• Follow-Up Appointment High Complexity 20 minutes: $290

• Other time billed at $700/hour

Good Faith Estimate / No Surprises Act: If you do not have health insurance or you plan to pay for medical bills yourself, Sean Murphy, PMHNPBC upon request will provide to you an estimate of expected charges. This is called a “good faith estimate.”

Limitations of Sean Murphy, PMHNPBC: The practice does not offer the following services—

a: Letters for Emotional Support Animals/ESAs or any other legal documentation

b: Forensic evaluations for legal purposes, such as custody/visitation evaluations, parental assessments, criminal legal involvement, gun permits

c: Disability evaluations, including Short-Term or Long-Term Disability or FMLA, determining leaves of absence from employment [*Sean Murphy, PMHNPBC will not provide any evaluation for the sole purpose of seeking medical or mental disability, or assist in determining ability to take leave from employment]

d: Substance use disorder treatment, including Suboxone or opiate-replacement therapies ORT/MAT

e. Special accommodations letters for colleges, universities, or places of employment

Emergencies: In the event of a medical or psychiatric emergency (for example, agitation, threats of suicide or violence, severe medication side effects, possible overdose, loss of consciousness), call 911 to be transported to the nearest Emergency Department. Providers there may contact Sean Murphy, PMHNPBC to discuss treatment.

Non-Emergency Contact: If an urgent situation arises (for example, mild medication side effects, changes in mood/behavior), call the clinic number (646-396-6105) or visit the patient portal to schedule an urgent appointment. Keep in mind that for safety and medicolegal purposes, medical questions require a face-to-face evaluation via a scheduled appointment.

After Hours: Calls will be returned within three (3) business days of receipt. Calling the clinic after regular business hours, on weekends, and/or on holidays will translate into longer wait-times for a return call.

Discharge Process: A professional patient-provider relationship might end when the patient decides to work with a different provider. The clinician may reach the clinical conclusion that a patient would be better or more safely cared for at higher level of in-person care than what can be offered by a solo provider in private telepsychiatric practice. In the case of discharge, the provider will make every attempt to discuss with the patient the reasons for discharge and will continue to provide emergency support for a time-limited period of 30 days after notification of discharge. Please note that ongoing failure to pay for treatment, nonadherence to the treatment plan (treatment plans include scheduling and attending sessions regularly, taking all medications exactly as prescribed, completing referrals, completing lab and imaging orders, collecting and reporting vital signs), self-adjusting or self-discontinuing medications without consulting the provider, failure to provide a full and accurate rendering of your medical history (including substance use, prior diagnoses, medication prescriptions, co-occurring disorders), or failure to communicate with the provider in a respectful and timely manner can also result in discharge from the practice.

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. PROVIDER’S PLEDGE REGARDING HEALTH INFORMATION: I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all the records of your care generated by this psychiatric practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information. I am required by law to:

• Make sure that protected health information (“PHI”) that identifies you is kept private.

• Give you this notice of my legal duties and privacy practices with respect to health information.

• Follow the terms of the notice that is currently in effect.

• I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website (www.murphynp.com).

II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU: The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures, I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all the ways I am permitted to use and disclose information will fall within one of the categories.

For Treatment Payment or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have a direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization in order to carry out the health care provider’s treatment, payment or health care operations. I may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your health condition.

Disclosures for treatment purposes are not limited to the minimum necessary standard because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.

Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:
1. Psychotherapy Notes. I do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:
a. For my use in treating you.
b. For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
c. For my use in defending myself in legal proceedings instituted by you.
d. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.
e. Required by law and the use or disclosure is limited to the requirements of such law.
f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
g. Required by a coroner who is performing duties authorized by law.
h. Required to help avert a serious threat to the health and safety of others.

2. Marketing Purposes. I will not use or disclose your PHI for marketing purposes.

3. Sale of PHI. I will not sell your PHI in the regular course of my business.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION.
Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons:

1.  When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.

2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.

3. For health oversight activities, including audits and investigations.

4. For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so.

5. For law enforcement purposes, including reporting crimes occurring on my premises.

6. To coroners or medical examiners, when such individuals are performing duties authorized by law.

7. For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.

8. For specialized government functions, including, protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.

9. For workers’ compensation purposes. Although my preference is to obtain an Authorization from you, I may provide your PHI in order to comply with workers’ compensation laws.

10. For appointment reminders and health related benefits or services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.

1. Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I believed it would affect your health care.

2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.

3. The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.

4. The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and I may charge a reasonable, cost-based fee for doing so.

5. The Right to Get a List of the Disclosures I Have Made. You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost-based fee for each additional request.

6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.

7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.

You have a right to file a complaint if you feel your HIPAA rights are violated. You can file a complaint by contacting the Practice using the following information:
Sean Murphy, PMHNPBC
69411 Ramon Road #39 Cathedral City, CA 92234
PRIVACY OFFICER: Jeffrey Bower
TELEPHONE NUMBER: 646-396-6105

You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

The Practice will not retaliate against you for filing a complaint.

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information.

EFFECTIVE DATE OF THIS NOTICE: This notice went into effect on 17 July 2024.