Privacy is important for patients seeking treatments, and our office protects this right to privacy dearly. There are exceptions to confidentiality, however. I understand that information given to Center for Adult & Child Psychiatry will be kept confidential and will only be released when: a written consent is obtained, a medical emergency occurs, a court order or subpoena is received; information is required by the insurance company and/or managed care firm to process claims and manage treatment; or a patient represents a serious danger to himself/herself or others. Lastly, if outstanding balances are not paid and not addressed, treatment information will be released for collection agency involvement. Privacy is of upmost importance for adequate therapeutic work to occur. Your support of this is critical to your treatment. (See our Notice of Privacy Practices for additional details)

Appointments & Cancellation Policy:

Always bring your insurance card with you. We will copy it at your initial appointment and verify the information at each follow-up appointment. A copy of the card will be made in order to bill your insurance. Your co-payment is due at the time of check-in for each visit. Please be prepared with cash or credit card.

If you must cancel or reschedule an appointment, we require at least 24-hour notice. Late cancellations (cancelling less than 24 hours before the appointment) and no show appointments will incur a fee of $75. Repeated cancellations of any type and/or not showing up for appointments may result in a referral to another treatment provider. Emergencies:For life threatening emergencies, please call 911 or go to your nearest emergency room. For urgent matters, please call the office, leave a message, and one of the covering psychiatrists will call you back. If you do not hear back within 15 minutes, please call again. If you do not hear back and your urgent matter has become an emergency, please call 911 or go to your nearest emergency room.

Medication Refills:

In general, medication refills are provided given the stability of the patient and frequency of monitoring needed. You may have your pharmacy fax a refill request form or contact our office by telephone. If your condition requires monitoring and the time since your last appointment has been longer than recommended, we may insist on an appointment and will generally provide you with enough medication until that appointment. In general, visits are frequent upon treatment initiation and then become less frequent as stability is achieved. Refills provided generally follow that pattern as well. It is utmost important that you schedule, and keep your appointments, so that you do not run out of medicines.
Controlled drugs cannot be refilled without an appointment

Your Rights Regarding Your Health Information:

Right to see and get copies of your records. In most cases, you have the right to review or get copies of your records. You must make the request in writing. You may be charged a fee for the cost of copying your records.

Right to request a correction or update to your records. You may ask CFAP to change (amend) or add missing information to your records if you think there is as mistake. Your request must be made in writing. In certain cases, we may deny your request for change.

Right to request limits on uses or disclosures of PHI. You have the right to ask that CFAP limit how your information is used or disclosed for the purposes of treatment, payment, and healthcare operations. You must make the request in writing telling CFAP what information you want to limit and to whom you want the limits to apply. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. If you have paid for your treatment completely out of pocket, you can request for CFAP not to provide information about your treatment to your insurance company.

Right to revoke permission. If you are asked to sign an authorization to use or disclose information, you can cancel that authorization at any time. You must make the request in writing. This will not affect information that has already been shared.

Right to choose how we communicate with you. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must request in writing. Your request must specify how or where you wish to be contacted. We will not ask you the reason for the request. We will attempt to accommodate all reasonable requests.

Right to get a paper copy of this notice. You have the right to ask for a paper copy of this notice at any time.

Contact Information: Unless otherwise specified, to exercise any of the rights described in this notice, Or for more information please call 407-602-7168.

Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please read it carefully.

To Our Patients:

Our office holds all your health information confidential. We are required, by law, to keep your health information private and provide you with this Notice of Privacy Practices. This Notice of Privacy Practice explains how Center for Adult & Child Psychiatry (CFAP) and its clinical staff and employees may share your Protected Health Information (PHI) with others for treatment, payment, health care operations, and other purposes allowed or required by law. This Notice of Privacy Practices is posted on our web site ( and is also available at the front check-in location.

Protected Health Information (PHI) is information about a patient’s age, race, sex, and other personal health information that may identify the patient. The information relates to the patient’s physical or mental health in the past, present, or future, and to the care, treatment, and services needed by a patient because of his or her health.

Healthcare Operations include activities such as discussions between CFAP staff and other health care providers, training clinic staff, interacting with insurance companies, carrying out medical reviews to measure quality, and managing business functions. CFAP uses medical records to record health information, to plan care and treatment, and to carry out routine health care functions. Examples of which are listed below:

  • Provide PHI to referring providers to create and carry out a plan for your treatment.
  • Provide PHI to your insurance company to file claims for payment.
  • May use PHI to review the quality of services you receive.
  • May send you reminders for appointments.
  • May share PHI with public health agencies as permitted by law.
  • Will use and disclose PHI when required by federal or state law, or by court order.For example, to investigate reports of abuse.
  • May use and disclose PHI for public benefits under other government programs.
  • May disclose PHI to law enforcement in order to avoid serious threat to the health safety of a person or the public.
  • May disclose PHI to your family or other persons who are officially involved in your medical care. You have the right to object to the sharing of this information.

Patient PHI Release Information:

To release patient PHI to other people for any reason other than treatment, payment, and health care operations (described above) or as required or permitted by law, we must have a permission form known as an Authorization Form signed by the patient or the patient’s parent or legal guardian. This form clearly authorizes how you (the patient) wish the information to be used and disclosed.


Monday 8:00 – 5:00
Tuesday 8:00 – 5:00
Wednesday 8:00 – 6:00
Thursday & Friday 8:00 – 5:00
Saturday & Sunday Closed

  (407) 602-7168