Monica Preder, ARNP, PMHNP-BC Psychiatric Nurse Practitioner

 At this time, I am only licensed as an Adult Psychiatric Mental Health Nurse Practitioner (PMHNP) to provide services to individuals who are physically located in Washington State during our sessions. I am not permitted to meet or provide treatment to any patients, whether new or existing, if they are outside the state of Washington. This includes travel for school, work, vacation, or any other reasons—even in the case of emergencies. 

If medication is recommended, I will go over the details with you, including the nature of your condition and why the medication is needed. We will also discuss how you might improve with or without medication. I will explain any alternative treatments that have not yet been tried and why they may not be suitable as a first option. Additionally, I will provide information about the type of medication being recommended, including the dosage, frequency, and details about the initial dose, maintenance dose, and dose range. We will review common side effects as well as those that may be more specific to your medical and psychiatric history. I'll also discuss any potential long-term effects from using the medication over time or from stopping it, such as tardive dyskinesia or withdrawal symptoms. Finally, we will talk about the risks of suddenly stopping the medication without medical guidance.

Psychotherapy can offer many benefits, but it’s important to understand that there are no guarantees about the outcomes. For therapy to be most effective, it requires you to be open and honest, address any challenges that come up, and actively participate in the process outside of sessions.

By the end of your initial evaluation, typically completed over the first two to three sessions, I will provide you with my initial impressions and a treatment plan. It’s important that you review this information along with your own thoughts and feelings. If you have any questions or concerns, we should discuss them as they come up.

I use Tebra to manage my clients’ medical insurance billing. 

Any billing questions or concerns should go directly to :

Phone: (425) 428-8228

Fax: (949) 864-3327

E-mail: monica@psychiatristnurse.com

Mailing address: 

Monica Preder ARNP, PMHNP-BC

P.O. Box 2156

Lynnwood, WA  98036-2156

You will be expected to pay for each session once Tebra submits your Superbill to your insurance company and determines your out-of-pocket responsibility, including any copay. If you are seeing me as an 'out-of-network' (OON) provider, I will reach out to you for payment once I receive the CPT codes after our last session. I typically send this information to Tebra on Fridays.

We accept personal checks and credit cards (Visa, MasterCard, Discover, American Express) for payment. Please be aware that there is a $25 fee for any returned checks. If payment is overdue for more than 60 days, I may take legal action to secure payment, which could involve collection agencies or small claims court. In most cases, the information shared would be limited to your name, the services provided, and the amount due.

Once your appointment is scheduled, you will be expected to pay for it unless you provide at least 48 business hours' notice if you need to cancel. Business hours are considered weekdays (Monday through Friday) from 9 am to 5 pm. For example, if you have an appointment on Monday, January 7th at 4 pm, you must cancel by 4 pm on Thursday, January 3rd to avoid being charged. If you don't provide at least 48 business hours’ notice or fail to show up for your appointment, you will be charged $50 for a missed 30-minute appointment and $100 for a missed 50-minute appointment.

If you need to cancel your appointment, you can do so yourself using the online scheduler, and you will have until 48 hours before your scheduled time without needing to follow the business hours mentioned above.

I understand that unexpected things happen, and you may miss an appointment due to circumstances beyond your control. Because of this, I will waive the fee for the first missed session. If I ever need to cancel an appointment, I apologize in advance and will reach out to you as soon as possible to reschedule. I will also make sure you have enough medication to get through to our next session.

If you miss a session and do not reach out within 24 hours to explain the reason or let me know that you still wish to continue treatment, any upcoming sessions will likely be canceled. I will typically email you to inform you that the appointment was missed, unless you’ve requested not to receive email communications. You will need to contact me to reschedule if you wish to continue care, and you will also be responsible for paying for missed sessions before scheduling any new ones.

If you are more than 10 minutes late to a 50-minute appointment or more than 5 minutes late to a 30-minute appointment, your session may be canceled. If this happens, you will be charged the missed appointment fee ($50 for a 25-minute appointment or $100 for a 50-minute appointment). 

It is my policy to provide medication refills only during scheduled follow-up appointments. I will not refill controlled substances outside of these appointments, unless we’ve previously agreed to an exception during a session. If you run out of a controlled substance medication before your scheduled appointment, I will not be able to refill it. Please do not adjust your medication dosage without consulting me first.

To help ensure you have enough medication to last until your next scheduled appointment, please keep track of when refills are needed. If you miss your follow-up appointment, your medications may not be refilled.

For non-controlled medications, please do not have your pharmacy send a refill request. It’s faster if you contact me directly so I can send the refill electronically. Also, please make sure you have a follow-up appointment scheduled. If you don’t, I may be less likely to provide a refill. Sometimes, I need to know when your next appointment is to determine how much medication to provide until then.

I recommend filling all your prescriptions at the same pharmacy, including those from other providers. This helps ensure extra safety by allowing the pharmacy to check for potential drug interactions.

Important Information About Controlled Medications

Controlled Medications such as benzodiazepines (used for acute anxiety) and stimulant medications for ADHD require extra monitoring. Some of this monitoring is legally mandated. For example, anyone prescribed ADHD stimulants must have a face-to-face consultation (which can be done virtually) at least every three months to continue receiving refills. For benzodiazepines, this must occur at least every six months. As part of my responsibility, I am required to check the Prescription Drug Monitoring Program (PDMP)—an electronic database that tracks prescriptions for controlled substances—before prescribing these medications.

For certain controlled substances, I also ask patients to complete at least two Releases of Information (ROIs) for different individuals. One ROI should be for the primary care physician (PCP), and the other should be for a trusted family member, friend, or therapist.

Further legal requirements related to prescribing controlled medications are detailed in the following section—the Ryan Haight Act.

TELEMEDICINE AND PRESCRIBING CONTROLLED MEDICATIONS

The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 was created to combat illegal internet pharmacies selling controlled substances. It became effective on April 13, 2009, along with regulations issued by the Drug Enforcement Administration (DEA). Under the Ryan Haight Act, a prescription for controlled substances through telemedicine requires at least one in-person medical evaluation before it can be prescribed.

During the COVID-19 public health emergency (PHE), the U.S. Department of Health and Human Services temporarily allowed telemedicine to replace the in-person evaluation for prescribing controlled substances (Schedule II-V). This flexibility will remain in place as long as the federally declared PHE is in effect. Once the PHE ends, the original requirement for an in-person evaluation will resume unless Congress or HHS extends this flexibility.

A proposed bill, the TREAT Act, aims to allow practitioners, including physicians and nurse practitioners, to prescribe Schedule III and IV controlled substances via telemedicine or in-person evaluation in specific cases. However, this bill has not yet become law.

Under the Ryan Haight Act, a prescription for controlled substances is only valid if it comes from a practitioner who has conducted at least one in-person evaluation of the patient or a covering practitioner. A covering practitioner can issue prescriptions on behalf of the primary practitioner if the patient was seen in-person or evaluated through telemedicine within the last 24 months, and the primary practitioner is temporarily unavailable.

There are situations where the in-person requirement can be waived, such as when a practitioner has a special registration from the U.S. Attorney General to practice telemedicine.

When the PHE ends, practitioners must comply with the Ryan Haight Act as follows:

• Patients  who have been seen in person during or before the PHE can continue      receiving prescriptions for controlled substances via telehealth.
• Patients who have never been seen in person by the prescribing practitioner      must have an in-person appointment before any new or renewal prescriptions for controlled substances can be issued after the PHE ends.

Please note: If an in-person visit is required to continue your controlled substance prescription, I want to make you aware of my location. I currently reside in Lynnwood, Washington, and am licensed only in Washington. This means I can only physically meet with patients in Washington to fulfill the in-person evaluation requirement.

I may not always be available by phone right away. I don’t answer calls when I’m with clients or otherwise occupied. On days when I don’t have scheduled appointments, like weekends, it’s possible I’ll be out of cellular range. If that happens, you can leave a message, and I’ll return your call as soon as I can, but please note that it may take one to two business days to respond to non-urgent matters.

If you haven’t heard from me and feel you cannot wait for a response, or if you're in a situation where you feel unsafe, please do one of the following:

1. Go to your local hospital emergency room, or
2. Call 911 or 988 and ask to speak with a mental health professional on call.

I will always try to notify you in advance of any planned time away and provide you with the contact details of the professional covering for me. If you email me while I’m out of the office for an extended period, you will receive an automated response letting you know when I’ll be back. While I’m out, I generally respond to emails as long as I have cellular or internet access.

When sending sensitive health information, I strongly recommend using Tebra’s patient portal, as it provides secure, HIPAA-compliant, encrypted electronic communication. 

Regarding email, while I am available via email, please understand that regular email is not a confidential means of communication unless both parties are using secure channels. I use Tebra’s patient portal to send and receive emails. For emails to be HIPAA-compliant, they must be sent using secure methods. I make it a practice to send and respond to only non-sensitive health information via email. One potential issue with email is that important messages can sometimes end up in "junk" folders on either my or your end, which can cause miscommunication. Fortunately, Tebra's patient portal does not have this issue, making it less likely that important communications will be missed.

Please be aware that regular email is not secure. Although it’s unlikely, there is a possibility that information in a standard email could be intercepted and read by unauthorized parties. Keep this in mind when sharing your personal health information.

Texting is also not considered a secure method for communicating health information. However, HIPAA allows texting of patient health information as long as the patient has consented to this method and is informed of the potential risks. Please let me know if you are comfortable with me texting you, and I will assume consent if you text me unless you specify otherwise. As with email, I aim to only send or respond to non-sensitive health information via text. I typically only text patients, especially if I need to share sensitive information, if I cannot reach them through Tebra or other secure methods. Since I can only reach patients through Tebra if they are logged into their account, I often text patients at the start of our scheduled appointment time if they haven’t logged in yet, to let them know I’m ready.

Tebra is the HIPAA-compliant platform I’ve selected for conducting “face-to-face” telemedicine sessions and securely sharing sensitive health information in writing. Tebra ensures the privacy and protection of your data across all forms of communication—whether audio, video, visual, or written. The platform uses end-to-end encryption to transmit data securely, meaning that even Tebra itself cannot access any identifiable health information shared during our sessions. I have Tebra installed on my Mac, iPad, and iPhone to make communication with you as efficient and secure as possible.

For use on Macs and PCs (as well as mobile devices), Tebra offers a range of useful collaboration features, including file sharing, group video calls, screen sharing, and instant messaging. Tebra is accessible on any mobile device, allowing us to meet “face-to-face” virtually and share written information, images, or documents. To use Tebra, you’ll need to create an account (link below) and install the Tebra app/software.

While Tebra offers a secure and easy-to-use experience, I understand that the setup process may be a bit cumbersome, especially if you're new to telemedicine tools. If you're using a smart device, I recommend starting by downloading Tebra from your App Store and clicking the link to my account below to get started. Once you have it installed, using the app is straightforward. If you're not particularly tech-savvy, I suggest allowing at least 10 minutes before our first scheduled session to complete the setup. Although I don’t consider myself an expert in tech, I’m happy to help if you run into any difficulties. 

Although it's not common, legal situations that require the testimony of a mental health professional can occasionally arise. However, providing legal testimony can sometimes damage the therapeutic relationship between a patient and their practitioner. Because of this, I ask that you seek independent forensic psychiatric or psychological services if such an evaluation or testimony is needed. If I am required to provide testimony, appear in court, or be deposed on your behalf, you will be responsible for covering my court fees, which are a minimum of $1,080 for a half day or $2,160 for a full day. 

If you’re dissatisfied with any aspect of your treatment, I encourage you to discuss your concerns with me so I can address them. Your feedback will be taken seriously and treated with respect. You are also welcome to request a referral to another mental health professional at any time, and you are free to end treatment with me whenever you choose. You have the right to receive considerate, safe, and respectful care, and to be treated without discrimination based on race, ethnicity, color, gender, sexual orientation, age, religion, or national origin. Furthermore, you also have the right to ask questions about any part of the therapy process, including my training and experience. It’s important to note that I will not engage in social or sexual relationships with any current or former clients.

I reserve the right to end our professional relationship under the following circumstances:

1. If I believe my services are no longer helpful to you.
2. If I think another professional might be better suited to your needs.
3. If you fail to pay for your session.
4. If you miss two consecutive appointments or frequently miss appointments.
5. If you  miss an appointment without notifying me (a "no-call, no-show") and do not contact me within 24 hours to express your desire to continue treatment.
6. If you refuse to cooperate with the treatment plan necessary to ensure your safety or the safety of others.
7. If you or anyone close to you behaves aggressively or disruptively toward me or my staff in the workplace.

Your Privacy Rights and How Information About You May Be Used or Disclosed

This notice outlines your privacy rights and explains how your health information may be shared, as well as how you can access it.

I. Confidentiality:

I will not disclose any information about you or even acknowledge that you are my patient without your written consent. My formal Mental Health Record includes details of the services provided to you, such as session dates, your diagnosis, symptoms, functional status, progress, and any psychological test results. Healthcare providers can share this information for treatment, billing, or healthcare operations purposes; however, I do not usually disclose such information unless you authorize it. You will need to give written consent either at the start of our relationship or when disclosure is required. You can withdraw this consent at any time by contacting me in writing.

II. Limits of Confidentiality:

There are certain situations in which I am allowed to disclose your mental health records without your consent or authorization. Some of these situations are mandated by law, while others are part of my personal policy. If you wish to receive services from me, you must agree to these policies on confidentiality and its limits. We can discuss this at any point during our work together.

I may disclose information about you without your consent in the following situations:

• Emergency: If you’re involved in a life-threatening emergency and I’m unable to ask your permission, I may share information if I believe it would be in your      best interest.
• Child Abuse: If I suspect a child is being abused or neglected, I am required by Washington State law to immediately report it to the Department of Social Services.
• Adult Abuse: If I suspect an elderly or vulnerable adult is being abused, neglected, or exploited, I must report this to the Washington Department of Welfare or Social Services.
• Health Oversight: If I witness any misconduct by another healthcare provider, I am obligated to report it to the appropriate licensing board. Additionally, if you are a healthcare provider, I may need to report to your licensing board if I believe your health condition puts the public at risk.
• Court Proceedings: If you are involved in a court case and your records are      requested, I will not release information unless you give written consent or a court order is issued. If subpoenaed, I will notify you, and you can file a motion to block it. However, while awaiting the court’s decision, I may need to submit your records in a sealed envelope to the court.
• Serious Threat to Health or Safety: If you share a specific and immediate threat of serious harm to yourself or others, I am required to take steps to protect the people involved, which may include notifying the potential victim or law enforcement, or seeking your hospitalization.
• Workers Compensation: If you file a workers' compensation claim, I may be      required by law to submit relevant mental health information to your employer, insurer, or rehabilitation provider.
• Records of Minors: State laws may limit the confidentiality of a minor’s records. For example, parents may have access to their child’s records, and certain evaluations related to civil commitments may allow others, like evaluators, to access therapy records.

Any other disclosure of your information not mentioned here will only occur with your written permission.

III. Your Rights and My Responsibilities:

• Right to Request Restrictions: You have the right to ask me to limit how your health information is used or shared. If you want to restrict the sharing of your information with others involved in your care, you need to submit a written request specifying the information to limit, whether the limitation is for use or disclosure, and to whom it applies. I am not required to agree to your request.
• Right to Confidential Communications: You have the right to request that I      communicate your health information in a specific way or to a specific location (for example, not using your home address or phone number). You must make this request in writing, specifying how or where you would like to be contacted.
• Right to an Accounting of Disclosures: You have the right to request a report of any disclosures made about your health information, except in cases where you’ve provided consent or authorization.
• Right to Inspect and Copy: You have the right to inspect and copy your health records. If you want a copy, you must submit a written request. Please note that I may charge a fee for copying and mailing your records. In some cases, I may deny your request, especially if it involves psychotherapy notes or information compiled for legal purposes.
• Right to Amend: If you believe that the information in your record is inaccurate or incomplete, you can ask me to amend it. Your request must be in writing and explain why the change is necessary. I may deny your request if the information is accurate or if it falls under categories I am not required to amend.
• Right to a Copy of This Notice: You have the right to receive a copy of this privacy notice. If I make any changes to this notice, I will provide you with an updated version and let you know the effective date.

Complaints:

If you believe your privacy rights have been violated, you may file a complaint by submitting it in writing to my office. You can also send a written complaint to the U.S. Department of Health and Human Services.

Appointments are currently conducted via telehealth; however, patients must be physically located in Washington State at the time of their appointment.