Practice Policies

Practice Policies & PROCEDURES

Welcome to The Wellness Center Pearland, PLLC (“me,” “I,” “The Wellness Center,” and “Practice”)! My name is Jacquana Dowson, DNP, M.Ed., MSN, FNP-BC, and I am a family nurse practitioner in Texas, Arkansas, Colorado, Iowa, Idaho, Indiana, Louisiana, Nevada, Nebraska, Tennessee, and Wyoming. Thank you for entrusting me to care for you. I require all clients to review and agree to these policies and procedures prior to beginning or continuing services with the Practice. Please take time to read this and raise any questions you may. I may update these policies and procedures at my discretion, and I will provide you with a copy of any updates.

If you experience a medical emergency
(including suicidal or homicidal thoughts), immediately call 911.

Insurance, Payment, and Cancellation

Cash Pay

The Wellness Center does not accept private insurance plans, Medicare, or Medicaid. This is a cash only practice. Please let me know if you have any questions about this. You understand that you are wholly responsible and liable for payment of all charges assessed for professional services rendered, including any cancellation fees.

Good Faith Estimate

You are entitled to receive a Good Faith Estimate of the expected charges for your services. The Practice will provide you with a Good Faith Estimate prior to your scheduled services or upon request.

Cancellations

I have reserved your appointment time specifically for you. Please be on time for your appointment. If you are more than 10 minutes late to your appointment, I reserve the right to reschedule. If you need to cancel or reschedule your appointment, please contact me during business hours and at least 24 hours prior to your scheduled appointment to avoid paying a late cancellation fee of $50. For Monday appointments, you must cancel by 12:00 p.m. on the previous Friday so I can offer that time to another client. If you do not show up for your appointment, I will charge you a no-show fee of $50.

Credit Cards

For your convenience, I ask that you keep a current credit card on file with the Practice. By providing your credit card information, you authorize the Practice to charge unpaid balances and fees to this card. The most common charges include payment for appointments and cancellation or no-show fees. I will save this credit card information in your file for future charges.
If you pay by check or with a credit card and that check or charge is returned to the Practice for any reason, you agree that the following will be charged to your card: your entire balance due, any returned check fees charged to the Practice, and a $50 fee to cover my billing services management of the situation. If you do not provide a valid credit card, any unpaid balances will be sent to collections. Collection agencies may impose additional fees on your bill.

Mandated Reporting

Child Abuse

Texas law requires me to report all child abuse to local law enforcement or the Texas Department of Family and Protective Services Child Protective Services (CPS) division. I must call CPS if I have reasonable cause to believe that a child who is known to me in my professional capacity may be abused or neglected. It is my policy to notify you prior to contacting CPS if, in my professional judgment, it is reasonable to do so. I will follow other states’ child abuse laws as applicable.

Elder and Disabled Adult Abuse

Texas law also requires me to report the abuse of elderly or disabled adults to the Department of Family and Protective Services. This may include physical, sexual, financial, or psychological abuse, neglect, or exploitation. It is my policy to notify you prior to making a report if, in my professional judgment, it is reasonable to do so. I will follow other states’ elder abuse laws as applicable.

Communication, Social Media, and Driving Policy

Communications

By providing me with the information on this document or by initiating communication with the Practice by unsecured email or text message, you authorize me to call, leave voicemails, and respond to your text messages. I will only contact you form nonmarketing purposes, including appointment reminders, billing and invoicing updates, and treatment questions. You also understand that communicating with me by unencrypted emails and via text messages may be unsecured. This also means that any of your protected health information (“PHI”) that is transmitted in this way, including information about your appointments, diagnosis, progress, and other individually identifiable information, may be unsecured. If you choose to communicate via text or email, please limit the content to general information (such as scheduling or asking for a time to talk via phone). Please be aware of privacy risks when using electronic means of communication.

Social Media Policy

I will not accept friend or contact requests from current or former patients on any social networking site. Adding patients or contacts on social networking sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our relationship.

No Driving

You cannot drive a vehicle or engage in any other activity that diverts your attention during the telehealth appointment. We may terminate the telehealth session if you are driving during the appointment. We encourage you to select a quiet, private location for the telehealth appointment where you can remain comfortable.

Privacy, Security, and Medical Records

Notice of Privacy Practices

I comply with all state and federal medical privacy laws, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH). These laws require that I protect the confidentiality and privacy of your health records and personal information. I have implemented privacy policies and procedures to ensure my compliance with these requirements.

Minors and Confidentiality

Communications between you and me are confidential. However, parents and other guardians who provide authorization for their minor’s treatment are often involved in their treatment and may have the right to most information about the minor’s treatment. Consequently, in my professional judgment, I may discuss the treatment progress of a minor client with the client’s parent or caretaker. Additionally, I will inform the parent or caretaker about serious concerns relating to the minor client’s safety or well-being, including the risk of harming themselves or someone else.

Medical Records

I maintain records about your treatment. If you want a copy of your records, or if you want me to send your records to another provider, please ask for a medical records request form. Please note that, in some instances, I may charge reasonable and cost based copying, postage, scanning, or digital storage device fees.

Scope of Practice

Scope of Practice

As a family nurse practitioner, I act within my scope of practice as a licensed professional in Texas. I utilize my best efforts to ensure that the services provided are consistent with my scope of practice, including education, training, experience, ability, licensure, and certification. I will refer you to another provider if you require care that is outside my scope of practice.

Overview of Telehealth Services

Method of Treatment

I will provide telehealth services to you electronically, using audiovisual communications and information technologies, including real-time interactive services. Should we experience difficulties with the telehealth platform service for your telehealth sessions, I may use a backup platform.

Considerations for Telehealth

Please allow sufficient time prior to your telehealth appointment to ensure your audio and, if applicable, video is functioning. If you are more than 10 minutes late to an appointment, I reserve the right to reschedule. I may ask you to verify your identity and location at the beginning of a telehealth appointment. If you bring someone into the room during the telehealth appointment, you consent to have that person present during your appointment while you receive telehealth services.

Scope, Standards, and Professional Ethics

I utilize evidence-based telehealth practice guidelines and standards of practice to the degree they are available, to ensure your safety, quality of care, and positive outcomes. Services provided through telehealth must satisfy the same standards of care and professional ethics as healthcare providers who use traditional in-person treatments with clients. I utilize my best effort to ensure that the services provided are consistent with my scope of practice, including education, training, experience, ability, licensure, and certification.

Our Relationship

When the standard of care does not require an in-person encounter, following evidence-based standards of practice and telehealth practice guidelines that address telehealth’s clinical and technological aspects, we may establish a provider-client relationship through telehealth alone.

Rights, Risks, and Benefits

You have the right to withdraw your consent to receive telehealth at any time without affecting your right to future care or treatment. You understand that there are risks and consequences of telehealth, including: • Information Disrupted. The transmission of your personal information could be disrupted or distorted by technical failures. • Information Interrupted. The transmission of your personal information could be interrupted by unauthorized persons. • Information Lost. The electronic storage of your personal information could be unintentionally lost or accessed by unauthorized persons. • Inadequate Information. The telehealth technology may not provide adequate information during the visit. If this occurs, we will inform you before the conclusion of the live telehealth interaction.

Plan in Case of Technology Failure

The most reliable backup is a phone. I recommend that you always have a phone available and that I know your phone number or that it is on record with the Practice. If you get disconnected from a video conferencing or chat session, please end, and restart the session. If you are unable to reconnect within ten minutes, I will call you from an unidentified number during our session time. If you are on a phone session and your phone disconnects, I will attempt to call you back.

Through my telehealth technologies and my policies, I seek to ensure that you have easy access to mechanisms for the following purposes: (1) to access, supplement, and amend your personal health information; (2) to provide feedback regarding the quality of the telehealth services provided; and (3) to register complaints. I endeavor to respond to emails, electronic messages, and other communications transmitted via telehealth technologies promptly.

Telehealth Technology and Equipment

I utilize technology and equipment that complies with all relevant laws, regulations, and codes for technology and technical safety for devices that interact with clients. All technology used by the Practice is compliant with HIPAA and has been determined to be sufficient in quality, size, resolution, and clarity such that I believe I can effectively provide telehealth services to you. Although I use specific technology platforms to provide services, I have no other affiliation with them.

Disclosure and Functionality of Telehealth Services

Before my treatment of you via telehealth, I will disclose, through direct communication, my telehealth terms and conditions of use, my privacy policy, my HIPAA Notice of Privacy Practices, and this document, the following:

  • The services I will provide and limitations on such services;
  • The costs and fees;
  • Any financial interests, other than fees charged, in any information, products, or services I provide;
  • Appropriate uses for, and limitations of, telehealth technologies, including in emergencies;
  • To whom I may disclose your client health information;
  • Your right to privacy related to your client health information;
  • Information collected and passive tracking mechanisms utilized.

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