***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