Online^* Psychiatric Care.

Your health information is protected under the Health Insurance Portability and Accountability Act (HIPAA). WeltonPA (operated by Welton Physician Associate PLLC) uses and discloses your Protected Health Information (PHI) only for treatment, payment, and healthcare operations, or as required by law. You have the right to:

• Access and receive a copy of your medical records
• Request corrections to your records
• Receive an accounting of disclosures
• Request restrictions on certain uses of your PHI
• Receive this notice in an alternative format

To exercise these rights, contact us in writing at 929-278-6050.

Under New York State Mental Hygiene Law and applicable Federal regulations, all patients have the right to:

• Receive dignified, respectful, non-discriminatory care
• Be informed of your diagnosis, treatment options, risks, and benefits
• Provide informed consent before treatment begins
• Refuse treatment and be informed of the consequences
• Participate in developing and reviewing your treatment plan
• Have your records kept confidential as required by law
• File a complaint without fear of retaliation

Pursuant to New York Public Health Law §2999-cc, patients must provide informed consent before receiving telehealth services. By scheduling and attending a virtual visit, you acknowledge:

• Telehealth is delivered via HIPAA-compliant video platform
• You are located in New York State at the time of the visit
• Technology limitations or outages may occasionally interrupt care
• You may request an in-person visit at any time
• Your provider is licensed in NYS and subject to NYS regulations

You will be asked to review and sign an informed consent form. This covers:

• Nature of psychiatric evaluation and medication management
• Potential risks, benefits, and alternatives to proposed treatment
• Your right to withdraw consent at any time
• Limits of confidentiality (see below)
• Emergency procedures and after-hours protocols

Your care is strictly confidential. However, there are legally mandated exceptions under New York State and Federal law, including:

• Duty to Warn / Tarasoff: If you disclose a credible, imminent threat of harm to an identifiable third party, we are required to take reasonable steps to protect that person
• Child & Vulnerable Adult Abuse: Suspected abuse or neglect must be reported to the NYS SCR (800-342-3720)
• Court Orders: Valid subpoenas or court orders may compel disclosure
• Imminent Danger to Self: If you present an imminent risk of suicide or self-harm, emergency intervention may be required

We ask for 24 hours' notice to cancel or reschedule an appointment. This allows us to offer your slot to another patient in need.

• Cancellations with less than 24 hours' notice may incur a $75 late cancellation fee
• No-shows (missed appointments without notice) may incur a $100 no-show fee
• Repeated no-shows may result in discharge from the practice
• Fees are due before the next appointment is scheduled

We understand emergencies happen, so please contact us as soon as possible.

WeltonPA follows all applicable NYS and Federal DEA regulations for prescribing, including:

• Controlled substances are prescribed only when clinically indicated following thorough evaluation
• All prescribing via telehealth complies with the Ryan Haight Act and applicable DEA telehealth regulations
• Patients may be required to use a single designated pharmacy
• Early refill requests and prescription sharing are grounds for immediate discharge
• Random urine drug screens may be required for certain controlled substance prescriptions

WeltonPA does not provide emergency psychiatric services. If you are experiencing a psychiatric emergency:

• Call 911 or go to your nearest emergency room immediately
• Call or text the 988 Suicide & Crisis Lifeline (call or text 988)
• Contact the Crisis Text Line: text HOME to 741741

For non-urgent after-hours questions, text 929-278-6050 and we will respond the next business day.

WeltonPA does not discriminate on the basis of race, color, national origin, sex, age, or disability in its health programs or activities, consistent with Section 1557 of the Affordable Care Act, Title VI of the Civil Rights Act, the Age Discrimination Act, and Section 504 of the Rehabilitation Act.

To file a discrimination complaint, contact the U.S. Department of Health & Human Services Office for Civil Rights at 1-800-368-1019 or hhs.gov/ocr.