***Disclaimer —this page is still under construction. Policies will be individually uploaded to this page for review in coming weeks, in the interim you may review the Practice Policies in full by clicking here.***
Below you will find my practice policies and other information included in my clinical services agreement. You will be able to e-sign these forms in your Patient Portal before we begin to work together. The purpose of providing you with this information is to promote transparency and allow an opportunity for you to be informed about my practice as early as possible to avoid any surprises before we schedule your initial assessment. Please review these policies carefully prior to submitting your New Patient Request and don’t hesitate to let me know if you have any outstanding questions — thank you!
Introduction to Practice
Service Agreement
About Moonbeam Wellness LLC
About Martyna Rusinowicz, MSN, PMHNP-BC
Communication Policies
General Disclaimer
Patient Portal
Telecommunication & Electronic Communication
After-Hours/Between Appointment Contact
Emergency or Crisis
Social Media Policy
Patient Care Policies
Intake Procedures
Appointment Information
Additional Notices
Treatment Planning & Coordination of Care
Financial Policies
Fee Schedule
Payment
Insurance Reimbursement & Billing
Practice Guidelines & Service Disclaimers
Clinical Appropriateness
Controlled or Prior Medication Agreement
Minors & Parents/Guardians
Disability Requests
Legal Appearances
Ethics, Professional Standards, & Complaints
Risks & Benefits
Diagnosis
Dismissal/Termination of Care
Patient Rights
Provider Initiated
Privacy & Confidentiality
Limits on Confidentiality
Storage of Records