At Horizon Psychiatry, we strive to provide timely and consistent care to all our patients. We value your time and ask that you also respect ours. Each appointment is reserved especially for you. When a session is missed without notice, or canceled at the last minute, it prevents us from offering that time to another patient who may be waiting for care. Missed, canceled, or rescheduled appointments with short notice limit access for others and disrupt clinic operations. To ensure fairness and efficiency, we maintain the following policy.

Appointment Confirmation and Reminders

As a courtesy, our office provides appointment confirmations, and reminders by text, email, or phone. However, these reminders are not guaranteed. It is your responsibility to remember and attend your scheduled appointments.

We strongly encourage patients to place their appointment on a personal calendar at the time of scheduling to ensure they do not forget.

At the end of each appointment, we will work together to find a mutually agreeable time for your next appointment.

If an appointment is not made at that time, or a sooner appointment is needed, or if appointments need to be canceled or rescheduled:

- Self-scheduling is available online through our patient portal

- If you prefer, appointments may also be scheduled by phone or secure messaging. Scheduling in advance helps ensure continuity of care and secures a time that works best for you.

Policy Guidelines

24-Hour Notice Required

- Patients must provide at least 24 hours’ notice to cancel or reschedule an appointment.

- Telehealth visits are an option if transportation is a concern.

Late Arrival / No-Shows

- Not arriving within 10 minutes of the scheduled appointment time, without prior communication, will be considered a no-show.

- At that point, it is typically too late to conduct a full appointment without delaying other patients.

- A $100 no-show fee will be charged for missed appointments or late arrivals considered a no-show.

Late Cancellations

Appointments canceled or rescheduled with less than 24 hours’ notice (but before the scheduled appointment time) will be charged a $50 late cancellation fee.

Prescription Refills

Missed appointments may result in a delay of prescription refills until you are seen by your provider.

Repeated No-Shows or Late Cancellations

- Three no-shows, late cancellations, or late reschedules within a calendar year may result in dismissal from Horizon Psychiatry.

- Consistent failure to attend appointments or provide adequate notice disrupts the continuity of your care and prevents other patients from receiving treatment.

Exceptions

We understand that unforeseen emergencies or extenuating circumstances may arise. Please contact our office as soon as possible if you experience an emergency that prevents you from keeping your appointment. We may, at our discretion, waive the fee in such cases.

Billing Responsibility

- Fees for no-shows and late cancellations are not billable to insurance and are the patient’s responsibility.

- Charges are automatically sent to the billing method on file.

- These charges must be paid before scheduling the next appointment.

We appreciate your cooperation in helping us provide care for all patients in a fair and effective manner. Please contact our office if you have any questions about this policy.

* PLEASE READ CAREFULLY

The safety and care of our patients is our highest priority.

At Horizon Psychiatry, controlled substances are prescribed cautiously to ensure patient safety. Not all medications are controlled substances. These medications are highly regulated by the Drug Enforcement Administration (DEA), and prescribing practices are closely monitored. State laws require additional safeguards when prescribing controlled substances. We want our patients to understand the seriousness with which we approach these medications.

Definition

A controlled substance is generally a drug or chemical whose manufacture, possession, or use is regulated by the government. This includes prescription medications designated by law and drugs with potential for misuse.

Many medications commonly prescribed for ADHD, anxiety, and insomnia fall under this category. Examples include:

ADHD Medications

- Focalin (Dexmethylphenidate)

- Ritalin (Methylphenidate)

- Adderall (Dextroamphetamine / Amphetamine)

- Vyvanse (Lisdexamfetamine)

Anxiety Medications

- Xanax (Alprazolam)

- Ativan (Lorazepam)

- Valium (Diazepam)

- Klonopin (Clonazepam)

- Tranxene (Clorazepate)

Insomnia Medications

- Ambien (Zolpidem)

- Restoril (Temazepam)

- Lunesta (Eszopiclone)

- Belsomra (Suvorexant)

- Sonata (Zaleplon)

- Rozerem (Ramelteon)

Patient Responsibilities

- Take medications as prescribed: Do not adjust doses, stop, or start these medications without discussing it with your prescribing provider. Self-adjusting controlled substances can be dangerous, potentially causing seizures, overdose, or death. Combining these medications with alcohol, narcotics, or other controlled substances can be life-threatening.

- Non-compliance consequences: Self-adjusting medications will be considered non-compliance. This may result in discharge from Horizon Psychiatry due to the risk to safe care management.

- No early refills: Controlled medications will not be refilled before the scheduled time. Insurance generally does not cover early refills.

- No replacement for lost/stolen medications: Keep medications in a secure place. Lost, misplaced, or stolen controlled substances will not be replaced.

Monitoring

Controlled substances are monitored through the Prescription Drug Monitoring Program (PDMP). We review and monitor prescriptions across states to identify multiple providers, pharmacies, or suspicious activity. We expect patients to fully disclose any controlled substances obtained from other sources, including emergency departments. Failure to disclose may result in discontinuation of controlled substances and/or dismissal from Horizon Psychiatry.

Dosage Changes

Changes in controlled substance dosages will occur only at scheduled appointments unless specifically discussed in advance with your prescribing provider. Previous prescriptions from other providers will be reviewed and may not be continued as-is. We prioritize safe dosing and may taper high doses or recommend alternative medications if appropriate.

Drug Screening

Patients may be required to complete urine or blood drug screens prior to or during treatment. Testing is the patient’s responsibility. Results indicating non-compliance (e.g., absence of prescribed medications or presence of non-prescribed substances) may result in discontinuation of controlled substances and/or dismissal from the practice.

We take this policy very seriously. Controlled substances have high potential for misuse and addiction. Many are intended for short-term use only. Our goal is to maintain your safety while providing effective care.

Information to be Completed by Cardholder

The undersigned agrees and authorizes Horizon Psychiatry to save the credit card information provided in this document or entered into my electronic health record.

I authorize Horizon Psychiatry to process the credit card as a “Card on File.” I understand that this authorization will remain in effect until the credit card account expires, at which time it will need to be updated. I may revoke this authorization at any time by submitting a written request to Horizon Psychiatry at the address listed above. If a charge is processed to the card on file and declined, I understand that I will be billed for any associated fees.

I understand that if an invoice is not paid by the due date, Horizon Psychiatry will charge the outstanding balance to my credit card on file. No-show or late cancellation fees may also be automatically charged at the time of the appointment.

I further understand that if there is a balance due after my insurance has processed my claim, my credit card on file will be charged for that balance without prior notification. This balance represents my responsibility as indicated on the Explanation of Benefits from my insurance company and is not considered “balance billing.”

I acknowledge that I am an authorized user of the credit card provided or have been given permission to use it. Horizon Psychiatry will cooperate with authorities in the event of any fraudulent use. I understand that I must have the cardholder’s permission to use this card.

Scope of Practice

We provide psychiatric evaluations, therapy, and medication management. We do not provide forensic evaluations or disability determinations.

Termination of Treatment Policy

We reserve the right to discontinue treatment if a patient:

- Misses multiple appointments without notice.

- Does not adhere to prescribed treatment plans.

- Engages in abusive or inappropriate behavior toward staff.

Crisis & Emergency Care Policy

For immediate crises, call 911 or go to the nearest ER. We do not provide 24/7 crisis support.

Purpose

At Horizon Psychiatry, our goal is to provide safe, effective, and patient-centered mental health care. This policy outlines the circumstances under which patients may be discharged from care to ensure continuity, safety, and appropriate treatment.

Policy Statement

Discharge from Horizon Psychiatry may occur when it is clinically appropriate, mutually agreed upon, or necessary to maintain patient or staff safety. Either the patient or the practice may terminate care at any time, with or without providing a specific reason. Discharge is conducted in a professional, ethical, and legally compliant manner, with efforts to ensure continuity of care whenever possible.

Important Note

Horizon Psychiatry provides services only within the state of Florida. Care cannot be continued if the patient is physically located outside Florida due to licensing and legal requirements.

Criteria for Discharge

Patients may be discharged under the following circumstances, but are not limited to these situations:

1. Treatment Completion

- The patient has met established treatment goals or objectives.

- Ongoing care is no longer clinically indicated.

2. Treatment Completion

- The patient voluntarily requests to terminate care.

- No reason is required for the patient to discontinue treatment.

- Discharge is documented in the patient’s record, and referrals or resources may be provided if further care is desired.

3. Non-Engagement or Inactivity

- Repeated missed appointments, no-shows, or failure to comply with scheduled care, despite outreach and documentation.

- Patients who have not been seen or contacted the clinic for more than six (6) months may be discharged due to inactivity, with documentation of attempted outreach.

4. Clinical Necessity

- The patient’s needs exceed the scope of services provided by Horizon Psychiatry.

- Referral to a higher level of care or specialized services is required.

5. Safety and Professionalism

- Patient behavior poses a threat to staff or other patients.

- There is zero tolerance for treating providers or staff unprofessionally, including harassment, threats, abusive language, or violations of professional boundaries.

- Patient refuses or does not agree to follow a safety plan and may be at risk of harm to themselves.

6. Medication Management Concerns

- Not taking controlled medications as prescribed.

- Requesting controlled medications from multiple providers or engaging in behavior suggestive of misuse or diversion.

7. Administrative Reasons

- Non-payment for services after appropriate notice and attempts to resolve the issue.

- Failure to maintain an active payment method on file for billing purposes.

- Repeated violation of clinic policies (e.g., prescription policies, safety rules) despite warnings.

Procedure for Discharge

- When clinically appropriate or administratively necessary, the provider may discharge the patient, and the patient may likewise terminate care at any time. No reason is required from either party.

- Written notice of discharge will be documented in the medical record, including any recommendations, referrals, or resources provided.

- For patients discharged for safety, unprofessional behavior, non-engagement, inactivity, medication management concerns, administrative reasons, or for being out of state, reasonable efforts will be made to ensure a smooth transition to other providers or resources.

- Emergent care needs or safety concerns will be addressed before discharge to prevent harm.

Follow-Up

- Patients may return to care at Horizon Psychiatry if circumstances change and clinical appropriateness is reassessed.

- Documentation of discharge, patient communications, and any referrals will be maintained according to regulatory and legal standards.

Review

This policy will be reviewed annually and updated as needed to reflect clinical, legal, and ethical standards.

This document provides important information about the federal law, the Health Information Portability and Accountability Act (HIPAA), which protects your privacy and outlines your rights regarding the use and disclosure of your Protected Health Information (PHI) for treatment, payment, and healthcare operations.

HIPAA requires that we provide you with a Notice of Privacy Practices (Notice) detailing how your PHI may be used and disclosed, and your rights regarding your health information. By signing this document, you acknowledge that you have received and reviewed the Notice. Electronic acknowledgment is considered valid. You may revoke this acknowledgment in writing at any time, though any action already taken based on your prior consent will remain valid.

Use and Disclosure of Protected Health Information

For Treatment:

We use and disclose your PHI internally as part of your care. Any disclosure of PHI to providers outside Horizon Psychiatry for your treatment will require your written authorization. Psychotherapy notes require specific authorization for most uses and disclosures.

For Payment:

We may use and disclose your PHI to obtain payment for services rendered.

For Healthcare Operations:

We may use and disclose your PHI as part of internal operations, such as quality review. We may also use PHI to inform you about services or educational programs that may benefit your care. PHI will not be used for marketing or fundraising purposes.

Minimum Necessary Standard:

We will only share the minimum necessary PHI needed to accomplish the intended purpose of treatment, payment, or healthcare operations.

Electronic Communications & Security:

If you choose to communicate with us via email, patient portals, or other electronic means, we will follow your preference; however, the security and confidentiality of such communications may be compromised. We take precautions to protect electronic communications but cannot guarantee complete security over non-secure methods.

HIV Disclosure:

Under HIPAA, public health authorities may collect and receive PHI for the purpose of preventing or controlling disease without your consent, in accordance with state or local laws. Providers may report HIV/AIDS cases to public health authorities without your consent. Any other disclosure of HIV-related information requires your written authorization, except as otherwise permitted by law.

Business Associates:

We may share your PHI with business associates (e.g., billing companies, transcription services) who are contractually obligated to protect the privacy of your information.

State Law Considerations:

Certain state laws may provide additional privacy protections for mental health, substance use, or other sensitive information. These protections will be followed in addition to HIPAA requirements.

Breach Notification:

If there is a breach of unsecured PHI, Horizon Psychiatry is required to notify you promptly and explain what occurred and the steps we are taking in response.

Record Retention:

Your PHI is retained according to applicable state and federal law. Records are securely stored and destroyed in a manner that protects your confidentiality when retention periods expire.

Patient Rights

- Right to Ethical Treatment: You have the right to receive care without discrimination based on race, ethnicity, gender identity, sexual orientation, religion, disability, age, or other protected status.

- Right to Confidentiality: You may request that PHI paid for out-of-pocket in full not be disclosed for payment or operations purposes. We will comply unless required by law.

- Right to Request Restrictions: You may request restrictions on certain uses or disclosures of PHI. We are not required to agree to all requested restrictions.

- Right to Confidential Communications: You may request PHI be communicated by alternative methods or locations.

- Right to Inspect and Copy: You may request to inspect or obtain copies of your PHI. Requests must be in writing; a copying fee may apply. Please allow up to 2 weeks for processing.

- Right to Amend: You may request amendments to your PHI. Requests must be in writing and include reasons for the changes. We will respond within 60 days.

- Right to a Copy of this Notice: You may receive a paper or electronic copy of this notice upon request.

- Right to an Accounting: You may request an accounting of disclosures of your PHI. Details will be provided upon request.

- Right to Appoint a Representative: A legal guardian may exercise your rights and make health information decisions on your behalf.

- Right to Choose Services: You may choose not to receive services. We can provide referrals to other qualified professionals.

- Right to Terminate Services: You may terminate services at any time. You are responsible only for services already rendered. We request that you notify us either during a session or by phone.

- Right to Release Information: With written consent, you may authorize the release of your PHI to any person or agency you designate. We will discuss any potential risks or benefits of releasing your information.

Clinician Duties

Horizon Psychiatry is required by law to maintain the privacy of your PHI and to provide this notice of our legal duties and privacy practices. We reserve the right to modify our policies and procedures. Any changes will be provided to you during a session or upon request. Until notified otherwise, we are required to abide by the current policies and practices described in this notice.

This policy is designed to ensure the safe and timely management of your medication needs. For your well-being, we require regular appointments to monitor your progress, discuss your treatment plan, and make any necessary adjustments. For most medications, your provider will prescribe a sufficient supply to last until your next scheduled appointment.

This policy outlines the procedures for requesting a prescription refill.

1. How to Request a Refill

Important: Please DO NOT ask your pharmacy to request a refill on your behalf. While we review communication from pharmacies, pharmacy-requested refill requests are discarded. All refill requests must come directly from the patient or a legal guardian. Relying on the pharmacy will result in a delay.

Preferred Method: The most efficient way to request a refill is through our patient portal. Log in to your account and send a secure message with the medication name and dosage. If multiple pharmacies are used, specify which pharmacy.

Alternative Method: You may also call our office during business hours at 407-347-4000. Please leave a detailed message including your full name, date of birth, medication name, dosage, and the pharmacy’s name and phone number.

New Pharmacy: If adding a new pharmacy, provide the name and either the street address or phone number.

2. Required Notice and Processing Time

Standard Refills: Please allow at least 3 business days for all refill requests to be processed. This allows our clinical team time to review your chart and approve the prescription. Prescriptions may sometimes be filled the same day or next day, but this is not guaranteed.

Planning Ahead: Contact us for a refill as soon as you are down to a one-week supply of your medication to prevent interruptions in treatment.

Timely Appointments: Your provider typically provides enough medication to last until your next scheduled appointment. It is your responsibility to schedule follow-up appointments to ensure continuity of care and avoid running out of medication.

3. Policy for Controlled Substances

For controlled substances (e.g., stimulants like Adderall or Vyvanse, benzodiazepines like Ativan or Klonopin):

- A new prescription requires an in-person or telemedicine appointment at least every 90 days. This is the minimum interval, and more frequent visits may be required, especially for new patients or when titrating medication.

- Any change in dose requires a new visit and may necessitate a sooner follow-up appointment to ensure safety and effectiveness.

- Prescriptions are generally limited to a 30-day supply at a time.

- Early refills are not provided under any circumstances.

- Lost or stolen prescriptions require a police report before any consideration of a refill. This is handled case by case.

4. After-Hours and Weekend Refills

Prescription refills are processed only during regular business hours (Monday–Friday, 9:00 AM – 5:00 PM). Providers do not refill prescriptions on evenings, weekends, or holidays. Please plan ahead to account for non-business days.

5. Patient Responsibility

- Patients are responsible for monitoring their medication supply and requesting refills in a timely manner.

- Notify the office of any side effects, changes in medications, or changes in health status.

- Keep follow-up appointments to ensure safe and effective ongoing treatment.

- Refills can be provided in the state of Florida. Please plan in advance if you are going out of state.

6. Electronic Prescriptions

All prescriptions are sent electronically directly to the pharmacy. Paper prescriptions are not provided. Make sure your pharmacy information is up-to-date to avoid delays.

7. Running Out of Medication

If you completely run out of medication, contact our office immediately. While we will try to assist, emergency refills cannot always be guaranteed. Running out due to missed or canceled appointments may result in treatment delays.

8. Importance of Follow-Up Appointments

Regular follow-up appointments allow us to:

- Assess your progress and symptoms

- Manage side effects

- Make dosage adjustments

- Ensure treatment remains safe and effective

- Complete documentation and review requirements

Please do not hesitate to contact our office with any questions regarding this policy.

* PLEASE READ CAREFULLY

This form is in addition to the Mental Health and Wellness Policies, Agreement and Consent Form, and Notice of Privacy Practices for Protected Health Information (HIPAA). Both forms must be signed to participate in Telehealth sessions.

Required Information at Every Telehealth Visit

- Patient name, current location, and telephone number at the time of the session. This ensures your provider can reach you or arrange alternative care in an emergency.

- Provider name, current location, and telephone number at the time of the session.

Telehealth may involve email, phone, or video technology. This document explains what you can expect when participating in Telehealth sessions.

Benefits of Telehealth

- Expands your choice of provider.

- Offers more convenient counseling options, including location and scheduling flexibility.

- Reduces time and costs associated with travel to an office.

- Allows real-time monitoring and reduces scheduling wait times.

- Increases accessibility for homebound clients, clients with limited mobility, or those without convenient transportation.

Limitations of Telehealth

- Technology limitations may prevent your provider from hearing or seeing everything clearly. You may be asked to repeat information.

- Technology may fail before or during a session; our backup communication method is by phone.

- While we take precautions, confidentiality breaches are possible.

- You may need to describe your feelings, thoughts, and behaviors in more detail than in face-to-face sessions.

Patient Responsibilities

- Stable Internet Connection: You must have a reliable internet connection to participate in video sessions. Sessions may be interrupted if connectivity is unstable.

- Professional Presentation: You must appear fully clothed, not smoking, and not under the influence of alcohol or other intoxicants.

- Private Environment: You must participate from a private location where others cannot overhear your session. Cars may not be used while driving.

- Minimize Interruptions: Please reduce distractions for the duration of the session and consider using a headset for confidentiality and audio quality.

- Licensing Compliance: Your provider may only practice in states where they are licensed. You must inform us if your location changes.

Connection Loss

Video Sessions: If video is lost, we will call you to troubleshoot. If the session cannot continue, we will either complete it by phone or reschedule any remaining time. If the connection issue is on your end, you will still be charged for the full session.

Phone Sessions: If the call drops, we will attempt to call you back twice. If we cannot reconnect, the session may continue once contact is re-established. Technology issues on your end do not reduce charges; issues on our end will allow alternative arrangements.

Safety

If there are concerns about your safety during a session, confidentiality may be broken to contact 911 or local emergency services and/or your emergency contact. All previously agreed exceptions to confidentiality remain in effect during Telehealth sessions.