Identification Policy

All patients must present a valid, non-expired state-issued Driver’s License, State issued ID card,

passport, or Passport ID card.

Confidentiality & HIPAA Compliance Policy

All personal health information (PHI) is stored securely in compliance with HIPAA. Identifiable

information will not be shared without consent, except as required by law.

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Telehealth Workflow Policy

At the beginning of each telehealth session, patient identity and location will be verified. If a
crisis arises, emergency services will be contacted at the patient’s location.

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Medication Management Protocols

Initial evaluations include a comprehensive history, Prescription Monitoring Program check, and
labs as appropriate. Ongoing care includes monitoring symptoms, side effects, and treatment
adherence. Our office will provide refills and renew prescriptions only during appointments. This
will reduce errors, improves patient safety, and ensures appropriate follow-up. Refills will not be

provided early without clinical justification.

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Controlled Substance Policy

Sunflower Psychiatry and Wellness provides controlled substances only when clinically
necessary for the appropriate management of a patient’s diagnosis. Prescribing controlled
medications is rare and considered only as a last resort after other treatment options have been
explored. All patients (or parents/guardians) prescribed controlled substances are required to
review and sign a Controlled Substance Agreement to ensure safe and responsible use.

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Crisis Policy

In case of psychiatric crisis (suicidal thoughts, homicidal thoughts, acute psychosis, severe
mania), immediate action will be taken. If imminent risk is present, 911 or local crisis services
will be contacted. All patients are provided with 988 Suicide & Crisis Lifeline information.

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No Show/Cancellation Policy

Appts should be cancelled at least 24 hours in advance. If not, there will be a $75 no-show/early

cancellation fee that will have to be paid before rescheduling.

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After Hours Policy

If you need to contact our office after hours, please leave a detailed message. Urgent concerns
will be addressed within 24 hours, and non-urgent calls within 48 hours. Our office will provide
refills and renew prescriptions only during appointments. This policy helps reduce errors,
improve patient safety, and ensure appropriate follow-up. For medical emergencies, please call
911 or go to the nearest emergency department. After hours line: 757-374-8839

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Financial Agreement and Insurance Verification Policy

Payment is due at the time of service. Patients are responsible for making sure they have active
insurance coverage for mental health-outpatient medication management services and that
Sunflower Psychiatry and Wellness is In-Network with your insurance plan. Any co-payment,
coinsurance, or deductible we charge is based on the benefits provided by your insurance
company. As a courtesy, we will verify your insurance benefits before your initial visit, but you
are solely responsible for this step. Patients are responsible for any outstanding balance if the
insurance carrier denies benefits, changes co-payment, alters your deductible, retracts a payment,
or does not provide benefits as estimated. Patients or the Responsible Party must pay the balance
regardless of the reason the insurance company denies coverage. Patients will be responsible for
requesting reimbursement from their insurance company if necessary. Superbill can be provided

at your request.

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Outstanding Balance Policy

Patients with an outstanding balance will be allowed one courtesy visit. After this visit, the
balance must be paid in full before additional appointments can be scheduled or prescription
refills provided. Failure to resolve the balance may result in suspension of services until payment

arrangements are made.

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Patient Dismissal Policy

It is your right to terminate treatment or your relationship with us for any reason. We reserve the
right to terminate the patient relationship at our discretion, via a non-voluntary discharge letter if

any of the following occur:

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 The Patient exhibits physical violence, physical or emotional intimidation, verbal abuse
of any kind, and/or the Patient or a Patient’s family member(s) carry weapons or engage
in illegal acts of any kind on the Provider’s premises or during treatment.

The Patient or a Patient’s family member(s) engage in abusive phone or email
correspondence. The Patient refuses to comply with stipulated clinic rules, refuses to
comply with treatment plans/recommendations, and/or does not make a payment in a

timely manner.

The Patient repeatedly cancels, late cancels, or no shows for appointments (3 visits).

Other cause deemed reasonable by the Provider in their sole discretion.

** Termination of the relationship by either party does not relieve the Patient or his/her

responsible parties of any outstanding fees due. **

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Records and External Paperwork Policy

Patients may request copies of their medical records with a signed Release of Information form.
A reasonable fee may be charged to cover the cost of copying and processing records. There is a
$50 fee for letters and a $75 fee for FMLA or Disability paperwork that needs to be completed
by the provider. FMLA or Disability paperwork will not be completed at the first visit. You will
need to be patient of Sunflower Psychiatry and Wellness for at least 6 months.