Practice Policies
Cranbrook Psychiatric Group, PLLC, reserves the right to amend these policies at any time. Updated policies will be posted on our website and/or provided in writing. Changes will apply prospectively. Continued receipt of services after notice constitutes acceptance of the revised policies.
High Priority Policies
Assessment
The initial appointments for you (or your child) are assessments. During this period, your clinician will gather information to better understand your needs and determine the most appropriate course of care. At the conclusion of the assessment, your clinician will determine whether treatment at our clinic is appropriate, or if referral to another provider or agency is appropriate.
Payments
You are required to keep a credit card on file. Your appointment may be cancelled if we do not have a credit card on file.
Cancellation Policy
We have a 2 business day cancellation policy. If you cancel your appointment with less than 2 business days notice, you will be charged a $150 fee.
If you are more than 15 minutes late to an appointment, it will count as a cancellation and you will be charged the cancellation fee. This fee is not covered by insurance. Please cancel/reschedule at least 2 business days in advance to avoid fees. Frequent cancellations will be discussed in session and may result in termination of treatment.
Urgent phone calls and care coordination
Urgent phone/video calls between scheduled sessions may be billed the same way as regular appointments. Communication to coordinate care that takes more than 15 minutes may incur additional charges and may not be covered by insurance.
Recording by AI scribes
We use a secure AI scribe for notetaking so your clinician can focus on you during the appointment. You can opt out anytime.
Practice Policies and Procedures
Appointments
Clients of Cranbrook Psychiatric Group, PLLC (the “Practice”) will be seen by appointment only. Please have your contact information and past records (if available) with you for the initial visit. Your consent and authorization will need to be provided to allow for review of previous records. There will be an initial assessment based either on a five- to fifteen-minute phone call or on your responses to our Appointment Request Form to determine whether the Practice is the best treatment choice for you. There is no charge for this assessment. If the Practice feels that it’s appropriate, it will schedule face-to-face assessment appointments – usually one or two for adults, and two to three for minors – to further determine whether the Practice is the most appropriate provider to treat you. The assessment appointments will be 90 minutes. You will be harged for these appointments per our normal fee schedule, which is available on our website.
Established Client appointments are generally scheduled for 30 minutes, including medication management appointments. Appointments must be cancelled or rescheduled 2 business days prior to the appointment time to avoid paying a late-cancellation fee. If you are late for an appointment by 15 minutes or more, the Practice will consider that as a no-show and charge a late-cancellation fee.
The no-show/cancellation fee is $150.
Frequent cancellations or no-shows will be discussed in session and may result in termination of your treatment.
Medication Refill Requests
Refill requests can be made by telephone. Please allow up to two business days from the time of the request for us to call in the refill.
Standard Business Hours
Monday through Thursday from 9 a.m. to 5 p.m. On occasion, appointments may be made during non-standard hours on a case-by-case basis.
Holidays and Closures
We observe office closures according to the public holiday schedule as follows:
New Year’s Day (January 1)
Memorial Day (last Monday in May)
Independence Day (July 4)
Labor Day (first Monday in September)
Thanksgiving Day (fourth Thursday in November)
Christmas Day (December 25)
Communications Policy
Please do not send urgent or emergent messages by voicemail or email. Currently the preferred method of non-urgent communication is through our encrypted email service, but we expect to have a secure Client Portal in the near future, which will then be the preferred method. Messages are responded to within two business days. If we are out of the office and additional delays are expected. If you do not hear back after this time, please re-send your email.
Phone messages are checked regularly after hours, on holidays, and on the weekends. We will reply to phone messages sent after-hours the following business day. All scheduling and refill requests should be made during normal office hours. If you decide to use non-secure methods of communication (for example, text messages or none-encrypted emails), your communications may be subject to theft, redisclosure, or loss.
Billing Policies
Your copayment (if you have applicable insurance) or out-of-pocket payment (if you do not have applicable insurance) is due at the time of service and may be made via credit card or Zelle. You must keep an active credit card on file with us. If the Client is a minor, the Client’s identified parent or guardian will be responsible for payment, and that person must keep an active credit card on file.
It is your responsibility to contact your insurance provider regarding coverage, deductibles, and co-pays. You must notify us of insurance coverage changes at least seven days before your next visit. If your insurance does not pay our claim within 45 days, the balance will be charged to the credit card that you have on file.
All balances that are more than 90 days overdue may be referred to a collection agency. Furthermore, failure to pay your balance may result in discharge from the practice.
It is the Client's responsibility to contact our practice with updated billing information, card information, and billing addresses.
Urgent phone/video calls between scheduled sessions may be billed the same way as standing appointments, in the Practice’s discretion. Communications by the Practice to coordinate Client care that take more than 15 minutes may incur additional charges and may not be covered by your insurer.
Non-Covered Services
Please be aware that some, if not all, of the services you receive may not be covered by your insurance plan. If you elect to have these services, you must pay for them in full at the time of service. Also be aware that your insurance plan may not consider a service you receive as being reasonable or necessary given your medical condition and will deny the Practice’s claim. Unless we have agreed with your insurance plan not to bill Clients for services denied for lack of medical necessity, you will be billed for the service.
Termination Policy
Effective psychiatric care requires a collaborative relationship. While we understand that life circumstances can create barriers to care, consistent engagement is necessary for clinical safety. This policy ensures that when a treatment relationship must end, it is done through a transparent, ethical process that prioritizes patient safety and continuity of care.
1. Disengagement Criteria
A patient may be discharged from the practice under the following circumstances:
Inactivity: Not being seen for an appointment within a 90-day period unless otherwise agreed upon.
Attendance: Missing or late cancellation of 3 or more appointments.
Non-adherence: Failure to follow the agreed-upon treatment plan (e.g., medications, lab work).
Failure to pay
2. Prescription Refills
To ensure safety, refills will not be provided if a patient has not been seen within the timeframe established by their clinician. Ongoing medication management requires regular clinical monitoring.
3. The Termination Process
When a relationship is ended due to client disengagement, the practice will take the following steps:
Written Notice: A formal 30-day termination notice will be sent via Certified Mail (return receipt requested) or Patient Portal (with read receipt). A secondary copy will be sent via regular mail or HIPAA-compliant email.
Stability Review: Before termination, the psychiatrist will review the patient’s most recent clinical data to assess stability. For patients lost to follow-up, this assessment will be based on the best available evidence in the record. If a crisis is suspected, we will attempt to reach the emergency contact on file.
Limited Coverage: For 30 days following the notice, we are available for care coordination and brief phone triage only. All appointments are by appointment only. Patients in crisis must utilize emergency community resources (ER or 988).
4. Transition of Care
The practice will assist the transition by providing:
Referrals: A list of at least three specific referral options or insurance directories.
Records: Clinical records will be transferred to a new provider upon receipt of a signed release of information form.
Crisis Info: Contact information for 988 and local crisis centers.
5. Immediate Termination
Care may be ended immediately, without a 30-day notice, for:
Physical threats or safety risks to staff.
Inappropriate or sexual misconduct.
Criminal conduct (e.g., drug diversion or property damage).
Client Agreement to Practice Policies and Procedures
I understand and agree to all of the policies and procedures described in this document. If I had any questions about any of them, I had the opportunity to ask questions and I received satisfactory answers.
I understand that contact on major holidays, nights, and weekends will be extremely limited.
I will communicate with the Practice primarily by email until the Client portal goes live, at which time I will use the Client portal. I understand and accept the risk of communicating with the Practice outside of a secure, HIPAA-compliant method.
I consent to receive text messages and voicemails from the Practice with appointment reminders and other information.
I consent to being contacted by the Practice at the email address and phone number that I have provided to it.
In the event of an urgent or emergent situation, I will call 911 or go to the nearest emergency department or urgent care center. I understand and agree to the Practice’s billing policies, and I agree to keep a valid credit card on file with the Practice.
I understand that my portion of the payment is due at the time of service. I understand and agree to pay my outstanding balance if my insurer does not pay the Practice’s claim within 45 days, and that my account may be referred to collections (and that I may be discharged from the Practice) if my payment is more than 90 days overdue.
Telehealth Informed Consent Agreement
Introduction
Telehealth is healthcare provided by any means other than a face-to-face visit. Telehealth services are conducted interactively from one site to another through electronic communications. Telephone consultation, videoconferencing, transmission of still images, e-health technologies, client portals, and remote client monitoring are all considered telehealth services.
By law, clients must be located in Michigan for all telehealth appointments.
Client Acknowledgments
I understand that telehealth services will be billed in the same manner as a regular office visit with Cranbrook Psychiatric Group.
I understand that all electronic medical communications carry some level of risk. For example, it is easier for electronic communication to be forwarded, intercepted, or even changed without my knowledge.
I agree that I will use a communications system on a secure network that cannot be accessed by employers, friends, or other unauthorized parties, and to protect myself from unauthorized use of my electronic communications by others. I release Cranbrook Psychiatric Group from all responsibility for breaches of confidentiality caused by me or by an unauthorized third party.
I agree that my healthcare information may be shared with other individuals for scheduling and billing purposes.
I agree to verify my identity and current location at the start of telehealth services.
I agree not to use electronic communication for emergencies or time-sensitive matters. I understand that a medical evaluation via telehealth may limit my healthcare provider’s ability to fully diagnose a condition or disease.
I agree to accept responsibility for following my healthcare provider’s recommendations.
I agree to engage in telehealth services despite the possibility of a technological problem or interruption.
Client Statement of Agreement
My signature and date are provided to evidence that I have read and understand Cranbrook Psychiatric Group Telehealth Informed Consent Agreement in its entirety. I have had the opportunity to ask questions, and my questions (if any) have been satisfactorily answered.
By signing this Telehealth Informed Consent, I hereby give informed consent for the use of telehealth in my medical care under the terms and conditions described herein, and I verify that:
I have read and fully understand the information provided above regarding telehealth, including its potential benefits, potential risks, and any practical alternatives.
I have had the opportunity to fully discuss the information contained herein with my provider and all my questions have been answered to my satisfaction.
I will be located in Michigan while receiving telehealth services.
I accept all the terms set forth in this document.
Consent for Treatment
I, the Client, voluntarily seek and consent to treatment by Cranbrook Psychiatric Group, PLLC (the “Practice”). I understand that all treatment by the Practice is voluntary and that I may stop treatment at any time. I have been informed of the nature of the treatment, the benefits and risks of the treatment, and alternative approaches for care. I voluntarily consent to the treatment recommended by my Practice provider. I understand that it is my responsibility to inform the Practice if there are any unexpected changes in my condition or if any problems arise relating to my treatment. I agree not to take pictures of or record (by any means including, without limitation, audio or video) my treatment without the express written permission of the Practice.
Notice of Privacy Practices
Privacy Officer
Farrah Laviolette, MD
Dr. farrah@cranbrookpsychiatric.com
(248) 971-0240
THIS NOTICE DESCRIBES HOW HEALTHCARE INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Cranbrook Psychiatric Group, PLLC (the “Practice”), provides psychiatric services. When you receive care from the Practice, we will create a client record, which can be paper, electronic, or both. The client record has information about your medical and/or mental health history and status, your treatments, and your progress. It may also contain sensitive information such as treatment for substance abuse or HIV.
Who Will Follow This Notice?
The Practice and your individual provider(s)
All other members of the Practice’s workforce
Summary of Our Uses and Disclosures
We may use and share your information without your consent to:
Treat you.
Bill for your services
Help with public health and safety issues
Comply with the law
Work with a medical examiner or funeral director
Address workers’ compensation, law enforcement, and other government requests
Respond to lawsuits and legal actions
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no ” if it would affect your care.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information.
You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
You can complain if you feel we have violated your rights by contacting us by email at Dr. farrah@cranbrookpsychiatric.com or by phone at (248) 971-0240
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S. W., Washington, D.C. 20201, calling (877) 696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:
Share information with your family, close friends, or others involved in your care
Share information in a disaster relief situation
Include your information in a hospital directory
We may also share your information when needed to lessen a serious and imminent threat to health or safety. We have no plans to share your information for the following purposes, but be assured that we will never do so without your written permission:
Marketing purposes
Sale of your information
Our Responsibilities
We are required by law to maintain the privacy and security of your protected health information.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in this notice and give you a copy of it.
We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.
Client Acknowledgment of Receipt
I am a client of Cranbrook Psychiatric Group, PLLC (the “Practice”). I acknowledge that:
I have received the Notice of Privacy Practices (the “Notice”) from the Practice.
I have been provided an opportunity to review the Notice.
I have asked any questions that I have about the Notice, and the questions have been answered to my satisfaction.
I fully understand the Notice and agree to its terms.
Consent to Recording and Use of Automated Scribe Note Taking Tool
Some or all of your communications with Cranbrook Psychiatric Group, PLLC, and the providers you interact with (collectively, the “Practice,” “we,” or “us”) may be transcribed through an automated scribe note taking tool. We use this automated scribe to capture the details of our discussion more accurately and efficiently. Use of this automated scribe allows our Practice to focus more on our conversation and less on manual note taking, enhancing the quality of care you receive. You can opt out at any time during your appointment by letting your provider know.
Information collected by the automated scribe is protected in accordance with our HIPAA. Notice of Privacy Practices and remains de-identified until placed into your medical record.
By signing this consent form, you acknowledge that:
You have been informed about the use of the automated scribe and its purpose.
You understand how your information will be protected.
You agree to allow your provider to use the automated scribe to assist with documenting.
You understand that you can withdraw your consent at any time without affecting the quality of care you receive.
Client Acknowledgment and Agreement
I, the Client, understand that the Practice uses an automated scribe note taking tool. The nature, advantages, and risks of using such tool have been explained to me, I have had a chance to ask questions, and all my questions have been answered to my satisfaction. I consent to the use of an automated scribe note taking tool by the Practice.
I have read, understood, and agree to the terms of this Authorization.
Confidentiality Notice and Disclosure of Limitations
Confidentiality
Your communications with your provider at Cranbrook Psychiatric Group PLLC (the “Practice,” “we,” “us” or “our”), are confidential and protected by Michigan and federal law. We are legally required to keep private what you tell your provider, except in the specific circumstances described below.
Limitations to Confidentiality
You should understand that confidentiality is not absolute. We are required or permitted by law to disclose information that you share with your provider in the following situations:
Risk of Harm to Self
If we reasonably believe that you present a clear and present danger to yourself and you explicitly refuse or by your behavior refuse to accept appropriate treatment, we may:
Contact family members or others who might assist in protecting your safety
Seek your voluntary hospitalization
Initiate proceedings for involuntary hospitalization
Notify law enforcement
Risk of Harm to Others
If you communicate to your provider, or anyone else at the Practice, an explicit threat to kill or seriously injure a specific, identifiable person and you have:
The apparent intent and ability to carry out the threat, OR
A known history of violence and a clear present danger of attempting to kill or seriously injure that person
Then we are required to:
Warn the threatened person(s)
Notify law enforcement in the area where you or the potential victim lives
Arrange for your hospitalization if necessary
Child, Elder, and Disabled Adult Abuse
Your provider is a mandated reporter under Michigan law. Your provider must therefore report to state agencies if your provider has reasonable cause to believe:
A child (under 18) is being abused or neglected
An elderly person (60+) is being abused, neglected, or exploited
A disabled adult is being abused or neglected
Reports go to the Department of Children and Families, local police, or the Department of Elder Affairs, as appropriate.
Court Orders and Legal Process
We must disclose information if ordered by a court or, under certain conditions, in response to a valid subpoena or other legal requirement. We will attempt to notify you when this occurs, unless prohibited by law.
Insurance and Third-Party Payment
We may disclose limited information to insurance companies, managed care organizations, or other third-party payers to process claims and determine eligibility. This is limited to information necessary for claims processing.
Collection of Professional Fees
We may disclose limited information (nature and dates of services, amounts owed) to collect fees for professional services. If you raise claims about the quality of your provider’s services as a defense, we may disclose additional information to defend against those claims.
Consultation and Supervision
Your provider may consult with other licensed mental health professionals, supervisors, or consultants regarding your treatment when we believe such consultation is clinically necessary. We will inform you in advance of the nature and purpose of such consultation unless you object. Consultants are bound by the same confidentiality obligations.
Group, Family, or Marital Therapy
In group, family, or marital therapy, communications made in the presence of other participants may be disclosed to other participants. Each adult participant must consent in writing to participate.
Criminal Conduct
Confidentiality may be breached if our communications reveal your contemplation or commission of a crime or harmful act.
Hospitalization Decisions
If we determine you need hospitalization for mental illness or present an imminent threat of dangerous activity, we may disclose confidential information to place or retain you in a hospital or to seek law enforcement involvement.
Your Rights
Right to Records: You have the right to request and receive a copy of your treatment records. Right to Authorize Disclosure: You may authorize me to disclose information to specific
individuals or entities by providing written consent that specifies what information, to whom, for what purpose, and for how long.
Privilege: Michigan law provides you with a legal privilege that allows you to prevent me from testifying about our communications in legal proceedings with certain exceptions. This privilege belongs to you alone.
No Consent Required for Mandatory Disclosures: When we are legally required to disclose information under the exceptions above, we may do so without your consent or prior notification, except as required by law.
Confidentiality After Death
Confidentiality obligations continue after your death to the extent permitted by law.
Security Limitations
Electronic communications (email, text, fax) may be less secure than in-person communication.
In emergencies, we may need to disclose information immediately to protect safety using insecure electronic communications methods.
Questions
Please ask us to clarify any aspect of this notice before we begin treatment.
Client Acknowledgment
I, the Client, acknowledge that I have received this confidentiality notice and understand the limitations to confidentiality in this professional relationship. By acknowledging below, I hereby agree to the terms of this Private Client Contract. I have read, understood, and agree to the terms of the Practice. By electronically signing below, I agree to all of the policies and procedures presented to me.