Consent for Medication Management

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This document contains important information about the professional services and business policies of both your Lyra Clinical Associates P.C. (LCA) physician, and Lyra Clinical Associates P.C. Please read it carefully and discuss any questions you have with your physician.

Confidentiality: Your physician and LCA take your privacy and confidentiality very seriously. LCA complies with Federal and state laws regarding confidentiality of client information. Our Notice of Privacy Practices details how we use any information we collect, including for treatment, coordination of care, payment and other business operations. We will minimize the amount of information we share without your express consent, however there are certain circumstances in which we may disclose details of your care:

  • Your physician may share information about your assessment and treatment with other members of the clinical team at LCA in order to improve your experience and guarantee that we are providing you with the most effective care possible. You may let us know that you do not want your information shared in this way by contacting us in writing.
    • Your physician may request or share information with another non-LCA provider for treatment activities, such as coordination, consultation, and referrals.
  • If there is suspected elder, dependent adult, or child abuse or neglect.
  • If, in your physician’s judgment, you are in danger of harming yourself or another person, or are unable to care for yourself.
  • If you communicate to your physician a serious threat of physical violence against another person; in these circumstances, your physician is required by law to inform both potential victims and legal authorities.
  • If your physician is ordered by a court to release information as part of a legal proceeding.
  • As otherwise required by law and detailed in our Notice of Privacy Practices.

The Process of Medication Consultations and Visits: The process and outcome of medication visits may vary depending on the particular problems addressed, the symptoms of the client, and various other factors. While we cannot predict exactly what your experience will be like, we are committed to providing you with the most professional and ethical treatment possible.

Participation in a medication consultation and possible follow up visits can result in a number of benefits to you, including changes in your presenting symptoms. Since these visits often involves discussing unpleasant aspects of your life, you may experience uncomfortable and intense feelings like sadness, guilt, anxiety, frustration and anger. In addition, your physician may prescribe certain medications during your visit, and will discuss this with you directly, including possible side effects. There are no guarantees about what you will experience. Your physician’s role is to help guide you through care by asking relevant questions, providing treatment plans and recommendations, and monitoring your treatment progress.

During your first session, you will discuss with your LCA physician the reasons you are seeking a consultation, goals you would like to achieve, and any background information related to your presenting concerns. You may or may not be recommended medications as a result of this consultation. If you are recommended medications in our platform and choose to follow up, you will be asked to complete assessments between sessions to monitor and guide care. Follow up visits will assess the medication, effects and side effects. The physician will go over an informed consent regarding medications. Please be aware that the Federal Ryan Haight Online Pharmacy Consumer Protection Act of 2008 prevents physicians from prescribing controlled substances through telemedicine without an in-person medical evaluation, and your LCA physician cannot prescribe medications falling into this category.

The Lyra Website: As part of care you will use Lyra Website. Your will need to access the Lyra Website to participate in the video sessions, submit assessments and practices in between sessions, as well as to connect with your physician via secure messaging.

Your physician will orient you to using the Lyra Website for the above purposes during your first session. If you decide to have your sessions with your physician by phone (without using the video option in the Lyra Website), your physician will call you at the number you provided at registration. You will still need to use the Lyra Website to complete and submit assessments.

Care Assessments: Before your first session, your physician will ask you to answer a set of questions that will help them get to know you and better tailor treatment to respond to your situation. Throughout your care, your physician will also assign other assessments to be completed before your sessions to inform treatment.

Video Care: Please note that:

  • As part of this program you will engage in telehealth sessions with your LCA physician.
  • All telehealth sessions are held by video using the Lyra Website.
  • Your physician will initiate the video session with you at the scheduled time using the Lyra Website.
  • The video conferencing technology will not be the same as an in-person session with a physician due to the fact that you will not be in the same room as your physician.
  • In order to have the best results for this session, you should be in a quiet place with limited interruptions when you start the session.
  • There are potential risks to this technology, including interruptions, unauthorized access and technical difficulties.
  • Your Lyra physician or yourself can discontinue the telehealth session if it is felt that the videoconferencing connections are not adequate for the situation.
  • Your LCA physician will inform you and obtain your consent if another person is present during the consultation, for any reason.
  • There are alternatives to a telehealth session available, and a member of our care team can assist you in accessing those options.
  • You can direct questions about your telehealth sessions at any time to your LCA physician or Lyra Care Advisor.
  • This consent will last for the duration of the relationship with your LCA physician, and it covers all telehealth sessions you may have.
  • You can withdraw your consent for telehealth sessions at any time, and Lyra will work with you to try to find a suitable alternative.
  • The same confidentiality protections, limits to confidentiality, and rules around your records apply to a telehealth session as they would to an in-person session.
  • Your LCA physician may decide to terminate telehealth services, if they deem it inappropriate for you to continue care through video sessions. Your LCA physician will work with other team members to identify another option for care. LCA physician for in-person care.
  • By signing this consent you agree to work with your LCA physician to come up with a safety plan, including identifying one or two emergency contacts, in the event of a crisis situation during your sessions.

Video Recording: Your physician will record all video sessions using the Lyra Website for quality assurance purposes. The recordings are kept for 8 weeks and then deleted. If you do not agree to have your sessions recorded for quality assurance please let your physician know at your first appointment.

Missed Appointments and Cancellations: LCA requires at least 24 hours advance notice for cancellation of an appointment. If you are unable to attend your scheduled appointment due to circumstances beyond your control, please message your physician in the Lyra Website as soon as possible so we can reschedule your appointment to a more suitable time. Once an appointment is scheduled, you will be expected to attend unless you contact your physician to reschedule. You can also use email to reschedule; however, please note that receiving emails in your personal account may be unsecure. Failure to provide sufficient notice for cancellations and/or repeated no-shows for your appointment may result in a fee assessed by LCA and may impact your ability to schedule additional appointments with your physician.

Messaging and Email Communication: If you need to contact your LCA physician between sessions, for non-urgent issues, please message them within the Lyra Website and they will address them as soon as possible. Your physician checks his/her messages in the Lyra Website regularly during business hours and will make every effort to return your message by the next business day. You can also use email to communicate with your LCA physician, however please note that receiving emails in your personal account may be unsecure.

Scope of Services
LCA physicians can only treat mental health related diagnoses. If you have a general medical concern, please address with your primary care physician.

Your LCA physicians may recommend medications as part of your consultation or visits. All of the medications prescribed are FDA approved for at least one indication and in most cases will be FDA approved for what is being addressed in your visits. On occasion, physicians may prescribe medications for uses that are not included in the FDA approval. Many medications have studies or uses that become apparent after their initial approval. Recommendations in these cases are offered with careful clinical consideration and use of evidence-based literature/research.

Release of Information
As part of continuity of care or if your LCA physician has a medical concern, you authorize them to contact your primary care physician. You also authorize your LCA physician to access your pharmacy and lab history. You may also be asked to sign a release of information for others who may be helpful in your care.

Emergency Procedures: In a crisis, please call 911, go to the local emergency room. Please do not use the Lyra Care messaging or email if you are experiencing an emergency.

If you experience an emergency during your sessions with your LCA physician, or if your LCA physician becomes concerned about your personal safety, the possibility of you injuring someone else, or about you receiving proper psychiatric care, your LCA physician and LCA will work within the limits of the law to prevent you from injuring yourself or others and to ensure that you receive the proper medical care. For this purpose, LCA or your LCA physician may contact the person whose name you have provided on the biographical sheet as your emergency contact.

Social Media Policy: LCA and our physicians believe that adding clients as friends or contacts on social media sites (e.g., Facebook, LinkedIn, etc.) can compromise clients’ confidentiality and privacy. Consequently, given the importance of client confidentiality, your LCA physician will not accept friend or contact requests from current or former clients on any social networking site. If you have questions about this, please bring them up during your session.

Billing and Payments: The fees for your sessions may be partially or fully paid for by your, or your eligible sponsor’s, employer or Health Plan, with or without any cost share to you, as long as you are eligible, and as long as further sessions are considered clinically appropriate. Please check with Lyra at (877) 505-7147 prior to your session if you have any questions about how your session will be covered. Please note that certain professional services outside of the presenting problems, such as chart preparation requests and participation in legal proceedings, may be outside the services paid for by your employer and may incur additional fees. Any additional fees will be discussed and agreed upon when they are requested. Fees for services may be subject to change in the future and we will notify you of any changes.

Research, Writing, Teaching: Your physician and others at LCA conduct internal research, training, and supervision. Your physician may use information about you and your treatment in any of these ways. Your physician may also prepare publications for professional and/or lay audiences, and may use information about your treatment in an anonymized way for these publications.

Length of Treatment: Your course of treatment will be individualized depending on the intensity and duration of your presenting concerns, your level of engagement and active participation in the treatment plan, and the specific nature of your concerns.

Ending Treatment: You may withdraw from treatment at any time. Your physician recommends that you discuss your plan to end treatment with them before taking action, so that they have an opportunity to offer further recommendations or referral options. Additionally, we recommend not discontinuing medications abruptly and without discussing with your physician.

If at any point during care your physician assesses that the sessions are not effective in helping you reach the therapeutic goals, he/she will discuss this with you and, if appropriate, end treatment. In such a case, they will work with you and the Lyra Care Team to identify alternative options.

If you do not keep your scheduled appointments and do not respond to communications from your physician, we will assume you have elected to end your treatment and we will close your case. If this occurs, and you wish to resume your treatment, please contact the Lyra Care Team to reinitiate care.

TREATMENT AGREEMENT
If at any time you have questions about the details above, please ask your physician or the Lyra Care Team. By continuing your sessions with your physician you accept and agree to abide by the contents and terms of this agreement and consent to participate in evaluation and/or treatment.