Terms and Conditions

Patient’s Rights and Responsibilities

As a health care consumer, you have the right to:

Choice of Service Providers – Choose or change your provider - If you decide to change providers, we will send you your patient records through the patient portal or you can sign a release of information with your new provider, and we will send your records to them directly.

Considerate and Respectful Care – Have your individual dignity respected regardless of age, gender identity, race, ethnicity, national origin, culture, sexual orientation, class, physical ability, genetic information, position in the community, lifestyle or other personal attributes.

Confidentiality and Privacy – Expect confidential treatment of all communications and records relating to you. Except as provided by law, your written permission must be obtained before information is given to anyone not directly connected with your care. Before you consent to a release of information, you may discuss what information will be released. You have the right to receive a written “Notice of Privacy Practices” that explains how your protected health information will be used and disclosed.

Interpreter Service – Request the services of an interpreter if needed, at no cost to you.

Know Your Fees – Be informed of fees incurred during your visit and of payment policies.

Responsive Service – Expect a timely response to any reasonable requests made for service. However, you do not have the right to insist on inappropriate or medically unnecessary treatment or services.

Records Access – Have access to information contained in the records within a reasonable time frame, except in certain circumstances specified by law.

Understanding – Be an active participant in decisions regarding your health. You have the right to understand, and to request information about, the following:

• Abundant Life Psychiatric Services' policies.

• The name and title of the person providing service to you.

• Our assessment of your care and treatment.

• What tests are being recommended and why.

• The prospects for resolution of your problem, and how this problem might be prevented in the future.

• What treatment and/or medication is recommended, its known side effects and known significant risks.

• Alternate courses of treatment or non-treatment, and the side effects and significant risks associated with each.

• The OpenNotes law and what it means for those you allow to access your health records electronically (e.g., your parents, spouse, or partner).

• Restricting the method by which your insurance carrier contacts you and/or provides information to you.

• Your right to refuse participation in any research projects.

• How to express concerns to the organization, either through Abundant Life Psychiatric Services’ procedures or through outside resources.

As a health care consumer, you have the responsibility to:

Answer Questions Fully – To the best of your ability, provide accurate and complete information to your health care providers about any matters pertaining to your health, any medications (including over￾the-counter products and dietary supplements) and any allergies or sensitivities. If it is not clear to you why certain information is relevant, please ask.

Make Sure You Understand – Confirm your access needs and understanding of services discussed and provided. Ask your healthcare provider about anything that is not clear, such as a diagnosis, treatment plan, test or policy. Diagnosis and treatment are often very individualized. Your symptoms may require the practitioner to differentiate between several diagnoses, or you may have to try more than one treatment plan to resolve your problem.

Be Open – Discuss how you feel about your visit -- anything from your treatment to your ability to pay fees.

Follow the Agreed-Upon Treatment Plan – Advise us whether you think you can, and want to, follow the agreed-upon treatment plan. The most effective plan is the one which all participants agree is the best and which is carried out exactly. If you choose to refuse or to not comply with the instructions given to you by your healthcare provider, you will need to accept the consequences of these decisions and actions.

Inform – Notify your health care provider about any living will, medical power of attorney, or other directive that could affect your care.

Report Changes – Tell us about any changes in your health or adverse effects of your treatment, or if your symptoms don’t improve. Also tell us about changes in your schedule, and let us know at least 24 hours in advance if you cannot make an appointment.

Know Your Health Care Providers – Try to know and remember the names of the people who serve you. We encourage continuity of care and will do our best to make this an easy task.

Respect Your Fellow Patients and Abundant Life Psychiatric Services' Staff – Show respect for the rights and property of your fellow patients and Abundant Life Psychiatric Services' staff by according them the dignity and courtesy that you expect to receive. Be considerate of the facilities and equipment. This includes responsibility for adhering to infection control policies and procedures with staff and within the facility.

Arrange Transportation – If required by your healthcare provider, provide a responsible person to transport you home from the facility and remain with you for 24 hours.

Pay Your Fees – Pay fees on the day of your service or make payment arrangements with the Administrator's Office to assure your financial obligations for your health care are fulfilled.

Maximize Healthy Habits – Take responsibility for your health by maximizing healthy habits such as exercising, eating a healthy diet and not smoking.

I understand that I am eligible to receive a range of services from my provider. The type and extent of services that I receive will be determined following an initial assessment and thorough discussion with me. The goal of the assessment process is to determine the best course of treatment for me. Typically, treatment is provided over the course of several weeks.

I understand that I have the right to ask questions throughout the course of treatment and may request an outside consultation. (I also understand that my provider may provide me with additional information about specific treatment issues and treatment methods on an as-needed basis during the course of treatment and that I have the right to consent to or refuse such treatment). I understand that I can expect regular review of treatment to determine whether treatment goals are being met. I agree to be actively involved in the treatment and in the review process. No promises have been made as to the results of this treatment or of any procedures utilized within it. I further understand that I may stop treatment at any time but agree to discuss thisdecision first with my provider.

I understand that telehealth participation may be utilized as part of my treatment when appropriate. I consent toparticipate in telehealth appointments when necessary for the purpose of assisting with diagnosis and treatment. I understand that telehealth involves the use of electronic communications to enable professionals to connect with individuals using interactive video and audio communications. Telehealth includes the practice of psychological health care delivery, diagnosis, consultation, treatment, referral to resources, education and the transfer of medical and clinical data. The potential risks to telehealth technology include interruptions, unauthorized access and technical difficulties. All laws concerning access to medical records and copies of medical records apply to telehealth. All confidentiality protections under federal and state law apply during your telehealth consultation. Healthcare information may be shared with other office staff for scheduling, billing and operating videoconferencing equipment. You will be informed of their presence and have the right to ask non￾medical personnel to leave the telehealth examination room and/or terminate the consultation at any time.

I am aware that I must authorize my provider, in writing, to release information about my treatment but that confidentiality can be broken under certain circumstances of danger to myself or others. I understand that once information is released to insurance companies or any other third party, that my provider cannot guarantee that it will remain confidential. When consent is provided for services, all information is kept confidential, except in the following circumstances:

• When there is risk of imminent danger to myself or to another person, my provider is ethically bound to take necessary steps to prevent such danger.

• When there is suspicion that a child or elder is being sexually or physically abused, or is at risk of such abuse, my provider is legally required to take steps to protect the child, and to inform the prop

This clinic is considered out-of-network with all insurance providers. Payment is due in full at the time of each appointment. If you have insurance and plan to file paperwork with them to be reimbursed for this appointment, please verify with your insurance company ahead of time that they provide reimbursement for out-of-network providers. Our providers have opted-out of Medicare and neither the client or provider are able to file for reimbursement with Medicare. This clinic is not responsible for what insurance companies decide to cover or reimburse. Psychiatric assessments and care is a non-refundable service.

Initial Psychiatric Diagnostic Assessment:

• $200.00 due at the time of appointment

• 45 – 60 minute appointment

• Purpose is to provide a diagnosis of present psychiatric disorders (ADHD, Bipolar, etc.) and treatment. The provider and this clinic are not responsible for the cost of lab orders, prescriptions, or what insurance companies decide to cover.

• NOT a psychological assessment (diagnosis of autism or developmental disabilities)

Medication Management Follow-Up Appointment:

• $100 due at the time of appointment

• 15 – 30 minute appointment

• Purpose is to provide continued health and medication monitoring. The provider and this clinic are not responsible for the cost of lab orders, prescriptions, or what insurance companies decide to cover.

Medication Management with Counseling Follow-Up Appointment:

• $200.00 due at the time of appointment

• 45 – 60 minute appointment

• Purpose is to provide counseling, education, coping skills, in addition to continued health and medication monitoring. The provider and this clinic are not responsible for the cost of lab orders, prescriptions, or what insurance companies decide to cover.

Medication Management Direct Pay Plan:

• Monthly direct pay plans are available upon request after the initial psychiatric diagnostic appointment. If you require monthly appointments, ask us about how a payment plan may help you save money.

Grant Availability:

• HealtHIE Georgia and Unite Rabun partner with us to provide grants for the treatment of opioid and alcohol use disorders. If you struggle with opioid or alcohol use disorder, ask us about how these grants may help you pay for treatment.

• The Powerful Project provides mental health scholarships for up to a year to help teens and young adults get back on their feet after a major financial life changing event.

• F.A.I.T.H. partners with us to assist in the payment of services for survivors of domestic abuse and sex trafficking.

We utilize text messaging to communicate with patients. This helps us respond quickly and send exact directions. We also understand that some patients are not comfortable keeping conversations involving mental health on their phone. Please opt-in for texting with Abundant Life Psychiatric Services directly through your patient chart. This will help document communications within your chart for providers to see. It will also help with providing announcements to clients about any upcoming changes to our services, consents, systems, or location. Message and data rates may apply. Text messaging is not an encrypted secure messaging system and does not fall under HIPAA compliance. By opting-in to text messaging the client acknowledges this and takes all risk and responsibility for Personal Health Information shared and discussed within text messages between themselves and Abundant Life Psychiatric Services, LLC. Clients may opt-out of text messaging at any time by replying STOP within the text message. Text messaging services are only available Monday - Friday 9:00 AM - 5:00 PM.

Starting January 1, 2025, a $10.00 late cancelation fee will be added to appointments that are canceled within 24 hours of the appointment time. This fee will increase to $20.00 effective July 1, 2026.

Abundant Life Psychiatric Services, LLC is not designed to handle medical or psychiatric emergencies. The client should NOT contact Abundant Life Psychiatric Services for any medical or psychiatric emergency. Therefore, the client should go to the nearest emergency room for any emergency. Additionally, the client may contact the following numbers in case of an emergency:

• Medical / Mental Health Emergencies: Dial 911

• Georgia Crisis and Access Line: Dial 800-715-4225

• 24/7 Crisis Text Line: Text HOME to 741-741

• National Suicide Prevention Lifeline: Dial or text 911

• Suicide Prevention Lifeline: Dial 800-273-TALK or 800-SUICIDE

At times we have nurse practitioner students at the office to aid in their education and future career. The comfort of our patients is important to us, so we like to know ahead of time how you feel about having students observe or participate in your appointments. If you decide at any point in time that you are not comfortable with student observation you may withdrawal consent at any time.