OFFICE POLICIES
Consent for Services
This letter of agreement confirms that you consent and authorize Thelma Angeles MD to provide you general adult outpatient mental health services in a Catholic perspective. These services may include medication management, supportive talk therapy , laboratory/psychological tests request, and other appropriate services.
Office Policies
Confidentiality
Your personal health information is confidential and will only be released to others with your written consent or permission, except when required by law to report suspected abuse to a child, a disabled person, or an elderly person; when you are considered a danger to self or to others; and when required by a judge to testify if you are involved in judicial proceedings. In certain situations Dr. Angeles may obtain professional consultation ensuring that only the minimum necessary information is disclosed.
Medication
Discuss your refill requests with Dr. Angeles during your office visits for continuous medication treatment.
Medication refills may take days to be available at your pharmacy and are not done on weekends or holidays. Refills will not be issued if you have not been seen and evaluated by Dr. Angeles within the past 6 months. Refills will not be issued if you meet the criteria for termination of treatment (see below).
Laboratory
Dr. Angeles may require you to have laboratory testing to screen for medical illness, to monitor dosing, compliance, and toxic effects of some medications like Lithium, Divalproex Sodium, and Clozapine.
She may order this for you or you may have your other physician/healthcare provider order this for you.
Fax your laboratory test results from your other provider(s) on your initial and or follow-up visits.
Health Insurance
Dr. Angeles is not a contracted provider with health insurance companies or Medicare or MediCal and is considered an out of network provider. She provides medical service on a fee-for-service basis only. Contact your health insurance company and inquire about your out of network benefits for possible reimbursement of a portion of your fee. You may on your own choosing, use the services of any physician who has not opted out of these health insurance companies.
Medicare Policy
Dr. Angeles provides medical service on a fee-for-service basis which is not reimbursible by Medicare.
You agree that you shall not ask Dr. Angeles to submit a claim for payment under Medicare for medical service
rendered, even if this service is covered by Medicare. This agreement applies only to Dr. Angeles and you. You may on your own choosing, use the services of any physician who has not opted out of Medicare.
Appointments and Cancellations
Keep your appointment as a time slot is saved only for you. Provide at least 24 business hours advance notice of cancellation of your scheduled appointment. A cancellation on the day of your scheduled appointment will incur an additional fee. Canceling too often may result to termination of your treatment.
Hospitalization
Dr. Angeles is not affiliated to any hospital and has no admitting privileges. If a crisis occurs, she will work with you to facilitate your hospital admission.
After-Hours/Emergency Policy
For emergency calls outside of normal business hours including weekends and holidays call 911 or proceed to the nearest hospital emergency room.
Payment
See Telepsychiatry page
Professional Fees
Please call Dr. Angeles’ office for questions regarding professional fees.
Additional Fees
The following services which require the time and expertise of Dr. Angeles may incur additional fees: telephone consult; statement or report to other clinical/spiritual providers, lawyers, courts, schools, insurance companies; court testimony; and other document preparation(s). Note that Dr. Angeles and her staff will use reasonable means to maintain the security and confidentiality of the information transmitted by fax or regular mail, however Dr. Angeles or any of her staff, are not liable for improper disclosure of confidential information caused by you or any third party.
Termination of Treatment
If you decide to discontinue treatment with Dr. Angeles, you can do so by phone or in writing. The following reasons may result to your discontinuation of treatment by Dr. Angeles: (1) noncompliance with recommended treatment, (2) cancelling too often, (3) not showing up for your appointments too often, (4) dangerous or inappropriate behavior in the office, (5) you need a higher level of care due to chronic suicidal intent and/or actions, excessive drug or alcohol use.
Clinical Record
Any information you disclose to Dr. Angeles or to her staff which is determined by them to be important in your
care, will be recorded in your clinical record.
Contact
PO Box 7272
Long Beach CA 90807
562-528-9119
Call for appointment and cancellation.
Any other request must be submitted in writing and mail to:
PO Box 7272
Long Beach CA 90807
This letter of agreement confirms that you consent and authorize Thelma Angeles MD to provide you general adult outpatient mental health services in a Catholic perspective. These services may include medication management, supportive talk therapy , laboratory/psychological tests request, and other appropriate services.
Office Policies
Confidentiality
Your personal health information is confidential and will only be released to others with your written consent or permission, except when required by law to report suspected abuse to a child, a disabled person, or an elderly person; when you are considered a danger to self or to others; and when required by a judge to testify if you are involved in judicial proceedings. In certain situations Dr. Angeles may obtain professional consultation ensuring that only the minimum necessary information is disclosed.
Medication
Discuss your refill requests with Dr. Angeles during your office visits for continuous medication treatment.
Medication refills may take days to be available at your pharmacy and are not done on weekends or holidays. Refills will not be issued if you have not been seen and evaluated by Dr. Angeles within the past 6 months. Refills will not be issued if you meet the criteria for termination of treatment (see below).
Laboratory
Dr. Angeles may require you to have laboratory testing to screen for medical illness, to monitor dosing, compliance, and toxic effects of some medications like Lithium, Divalproex Sodium, and Clozapine.
She may order this for you or you may have your other physician/healthcare provider order this for you.
Fax your laboratory test results from your other provider(s) on your initial and or follow-up visits.
Health Insurance
Dr. Angeles is not a contracted provider with health insurance companies or Medicare or MediCal and is considered an out of network provider. She provides medical service on a fee-for-service basis only. Contact your health insurance company and inquire about your out of network benefits for possible reimbursement of a portion of your fee. You may on your own choosing, use the services of any physician who has not opted out of these health insurance companies.
Medicare Policy
Dr. Angeles provides medical service on a fee-for-service basis which is not reimbursible by Medicare.
You agree that you shall not ask Dr. Angeles to submit a claim for payment under Medicare for medical service
rendered, even if this service is covered by Medicare. This agreement applies only to Dr. Angeles and you. You may on your own choosing, use the services of any physician who has not opted out of Medicare.
Appointments and Cancellations
Keep your appointment as a time slot is saved only for you. Provide at least 24 business hours advance notice of cancellation of your scheduled appointment. A cancellation on the day of your scheduled appointment will incur an additional fee. Canceling too often may result to termination of your treatment.
Hospitalization
Dr. Angeles is not affiliated to any hospital and has no admitting privileges. If a crisis occurs, she will work with you to facilitate your hospital admission.
After-Hours/Emergency Policy
For emergency calls outside of normal business hours including weekends and holidays call 911 or proceed to the nearest hospital emergency room.
Payment
See Telepsychiatry page
Professional Fees
Please call Dr. Angeles’ office for questions regarding professional fees.
Additional Fees
The following services which require the time and expertise of Dr. Angeles may incur additional fees: telephone consult; statement or report to other clinical/spiritual providers, lawyers, courts, schools, insurance companies; court testimony; and other document preparation(s). Note that Dr. Angeles and her staff will use reasonable means to maintain the security and confidentiality of the information transmitted by fax or regular mail, however Dr. Angeles or any of her staff, are not liable for improper disclosure of confidential information caused by you or any third party.
Termination of Treatment
If you decide to discontinue treatment with Dr. Angeles, you can do so by phone or in writing. The following reasons may result to your discontinuation of treatment by Dr. Angeles: (1) noncompliance with recommended treatment, (2) cancelling too often, (3) not showing up for your appointments too often, (4) dangerous or inappropriate behavior in the office, (5) you need a higher level of care due to chronic suicidal intent and/or actions, excessive drug or alcohol use.
Clinical Record
Any information you disclose to Dr. Angeles or to her staff which is determined by them to be important in your
care, will be recorded in your clinical record.
Contact
PO Box 7272
Long Beach CA 90807
562-528-9119
Call for appointment and cancellation.
Any other request must be submitted in writing and mail to:
PO Box 7272
Long Beach CA 90807