SHARED PRACTICE POLICIES & PATIENT INFORMATION

Clinic: Emily Wood, MD, PhD
Phone: 310-400-6685
Fax: 844-269-5439
Website: www.emilywoodmdphd.com
Email: info@emilywoodmdphd.sprucecare.com

Effective Date: June 1, 2026

This document applies to all providers at this practice. It describes shared policies governing your care, your rights as a patient, and the terms of your relationship with this practice. You will also receive a provider-specific clinical consent for each clinician treating you.

Please read both documents carefully. If you have any questions or concerns about the healthcare or business practices of this office, please feel free to discuss them with your provider at any time.

I. Practice Overview

This is a multidisciplinary outpatient practice providing psychiatric, psychological, and occupational therapy services. All providers operate within this shared practice structure and use shared administrative systems, including the electronic health record and billing platform. A Business Associate Agreement (BAA) governing the use and protection of your health information is in place. Providers and administrative staff involved in your care or billing may have access to your records.

II. Payment

Payment is due at the time of service. The following payment methods are accepted:

  • Credit card
  • ACH (bank transfer)
  • Check

A credit card is required on file for all patients. Card information is stored securely through the Jane App; only the last four digits are accessible to practice staff. Your card on file may be charged for outstanding balances, late cancellation fees, or no-show fees in accordance with the policies in this document.

Returned check fees are the patient's responsibility.

Credit card disputes: If you have a concern about a charge, please contact the practice directly before initiating a dispute with your card issuer. Most billing questions can be resolved promptly. Initiating a dispute without first contacting the practice may result in termination of the treatment relationship.

Delinquent accounts: Unpaid balances may result in suspension or termination of treatment and/or referral to a collection agency or small claims court.

III. Insurance and Superbill

At this time, all providers at this practice are out-of-network with insurance companies. Unless otherwise informed, you are personally responsible for the full cost of your treatment. However, many plans — including most PPOs — will reimburse a portion of fees paid to out-of-network providers. Most insurance companies will also cover prescriptions and laboratory tests ordered in the course of your care.

Upon request, we can provide you with a detailed statement called a superbill documenting services rendered, diagnostic codes, and payments made. You may submit this documentation to your insurance company for consideration for reimbursement.

It is your responsibility to understand your insurance coverage. Please contact your insurance company in advance of your first visit to determine what out-of-network benefits, if any, are included in your plan, and what out-of-network deductibles must be met before reimbursement begins. You remain responsible for any co-pays, co-insurance, or deductibles that are not covered.

Additional terms regarding insurance and superbills:

  • Reimbursement is not guaranteed and is determined entirely by your insurer. This practice is not responsible for insurer coverage determinations.
  • Submitting a superbill to your insurer may prompt your insurer to request access to your medical records. Your provider will not release records to an insurer without your authorization, but this is a consequence of insurance submission you should consider before submitting.

IV. Confidentiality and Its Limits

All information shared in the course of your care is confidential and will not be disclosed without your written authorization, except as required or permitted by law. The following are legally mandated exceptions:

  • Duty to Protect (Tarasoff): If you communicate a serious and credible threat of harm to an identifiable third party, your provider is required by California law to take reasonable steps to protect that person, which may include warning the potential victim and/or notifying law enforcement (Cal. Civ. Code §43.92).
  • Mandated Reporting — Child Abuse (CANRA): Your provider is a mandated reporter and is required to report known or reasonably suspected child abuse or neglect to the appropriate authorities (Cal. Penal Code §11164 et seq.).
  • Mandated Reporting — Elder and Dependent Adult Abuse: Your provider is required to report known or reasonably suspected abuse, neglect, or exploitation of elders (age 65+) or dependent adults (W&I Code §15630).
  • Psychiatric Emergency: If your provider determines that you pose a danger to yourself or others, or are gravely disabled due to a mental health condition, they may initiate steps to evaluate for an involuntary psychiatric hold pursuant to California Welfare & Institutions Code §5150.
  • Court Orders: Your provider may be required to disclose records or provide testimony in response to a valid court order or subpoena. We will notify you of any such request to the extent permitted by law and will seek to protect your information.

This practice is governed by HIPAA, the California Confidentiality of Medical Information Act (Civil Code §56 et seq.), and Welfare and Institutions Code §5328, which provides heightened protection for mental health records. Where California law is more protective than HIPAA, the California standard applies. Your full privacy rights are described in the Notice of Privacy Practices, provided as a separate document.

Minor Patients

For patients under 18, parents or legal guardians generally have the right to access their child's medical records. California law provides certain exceptions. Pursuant to Health & Safety Code §124260 and Welfare & Institutions Code §5850, minors of sufficient maturity may consent to and receive confidential outpatient mental health treatment without parental consent under specified circumstances. In such cases, information shared by the minor in that treatment may not be disclosed to parents or guardians without the minor's consent. Your provider will discuss the specific confidentiality parameters with both the minor patient and their family at the outset of treatment.

V. Emergency Procedures

Do not contact your provider or use any practice communication platform in a psychiatric or medical emergency. These channels are not monitored continuously and cannot guarantee a timely response.

In an emergency:

  • Life-threatening emergencies: Call 911 or go to the nearest hospital emergency room.
  • Suicide and mental health crisis: Call or text 988 (Suicide and Crisis Lifeline), available 24/7 from anywhere in the United States.
  • Los Angeles County Help Line: (800) 854-7771, https://dmh.lacounty.gov/get-help-now/, available 24/7 in Los Angeles County

VI. Research and Teaching

Providers at this practice hold academic affiliations and are engaged in ongoing teaching and educational activities. De-identified clinical material — information from which all identifying details have been removed — may occasionally be used for educational or training purposes. No individually identifiable information will ever be shared without your explicit written authorization.

VII. Communication Outside of Appointments

General Policy

Your provider may be reached by phone or through the practice's HIPAA-compliant communication platforms (Spruce Health and Jane). These channels are not for emergencies. All communications — including texts, emails, and voicemails — become part of your medical record.

Response Times

  • Urgent matters: Your provider will attempt to respond within one business day.
  • Routine matters: Responses are typically provided the same business day during regular business hours.
  • After-hours and weekends: Contact is limited to urgent clinical matters. Non-urgent questions should be submitted during business hours or held for your next appointment.

Security Limitations

Standard email and text messaging are not fully secure and carry inherent privacy risks. By signing this form, you acknowledge these limitations. Where possible, your provider will communicate through the practice's HIPAA-compliant platforms. If you choose to communicate via standard email or text, you accept the associated risks.

Opting Out of Communication Channels

You have the right to opt out of any specific communication channel at any time by submitting a written request to the practice specifying which channel(s) you wish to exclude.

VIII. Social Media Policy

  • No personal social media contact: Do not send friend requests, follow requests, or personal messages to your provider's personal social media accounts. Providers will not accept such requests from current or former patients.
  • Professional accounts: Providers may maintain professional public accounts for educational or advocacy purposes. If you choose to follow a professional account, your activity may be visible to others and is not a substitute for clinical communication.
  • Do not contact your provider via social media regarding clinical matters. Such messages may not be received in a timely manner and are not part of the clinical record.
  • Emergency review: In an emergency, your provider may review publicly available social media information to assess safety.
  • Review sites: Providers do not respond to online reviews in order to protect patient confidentiality. If you choose to leave a review, you may wish to use a pseudonym to protect your own privacy.

IX. Provider Availability and Absences

Providers will make reasonable efforts to notify you in advance of planned absences. This practice does not arrange clinical coverage during provider absences. If you have an urgent need when your provider is unavailable, please contact your primary care provider, call 988, or call 911. Non-urgent matters will be addressed upon your provider's return.

Emergency planning — including what to do if an urgent need arises during an absence — will be discussed as part of your care.

X. Cancellation and No-Show Policy

Advance notice to cancel or reschedule:

  • Initial intake & assessment appointments: At least 48 hours' notice is required.
  • All other appointments: At least 24 hours' notice is required.

Fees

  • First late cancellation or no-show: No charge.
  • Second and all subsequent late cancellations or no-shows: The full appointment fee will be charged.

Should a patient not arrive within 15 minutes of their scheduled start time without prior notice, the clinician is entitled to treat the appointment as a no-show and conclude their availability for that session. The full session fee will apply. If you are running late, please notify your clinician as soon as possible so that arrangements can be made where feasible.

Late cancellation and no-show fees are not reimbursable by insurance. You are responsible for these fees regardless of your coverage or out-of-network benefits.

Exceptions may be made at provider discretion for documented emergencies, hospitalization, or other circumstances beyond your control.

A pattern of repeated late cancellations or missed appointments may result in discharge from services.

Deposit Policy

A deposit equal to 50% of the appointment fee is required at the time of booking for all initial intake and assessment appointments. This deposit is applied toward your appointment fee. If you cancel with the required advance notice (48 hours or more), your deposit will be refunded in full. If you cancel with less than 48 hours' notice or do not show, the deposit is forfeited.

XI. Access to Records and Right to a Second Opinion

You have the right to access your medical records and obtain copies upon written request, subject to applicable law (Cal. Health & Safety Code §123110; HIPAA 45 CFR §164.524). You also have the right to seek a second opinion from another qualified clinician at any time. Your provider will cooperate with the transfer of records as needed.

Maintaining clinical records for every client is both a legal requirement and a core part of responsible clinical practice. Your file may contain demographic information, medical and developmental history, assessment results, treatment goals and plans, session notes, and billing records.

Clinical records are written as professional documents intended for use within a healthcare context. You have the right to inspect and obtain copies of your medical record upon written request, consistent with California Health & Safety Code §123110 and HIPAA. Requests will be responded to within the timeframes required by applicable law. In limited circumstances, your provider may determine that providing access to specific records could cause substantial harm to you or another person; in such cases, your provider will notify you of the denial and the basis for it, and you retain the right to challenge that determination as provided by law.

Psychotherapy notes — defined under HIPAA as notes documenting the contents of therapeutic conversations, maintained separately from the rest of your medical record — are subject to different rules. Under federal law, these notes are not included in the general right of patient access and may be withheld at your provider's discretion. Your provider will discuss the contents of your record with you clinically upon request, and can facilitate transfer of relevant records to another treating professional when clinically indicated.

Any professional time spent preparing, compiling, or responding to documentation requests will be billed at the standard prorated hourly rate.

XII. Discharge and Termination of Treatment

Voluntary Termination

Either party may end the treatment relationship at any time. You are never required to continue treatment against your wishes.

Provider-Initiated Termination

If your provider initiates termination, a 30-day transition window will be provided whenever clinically feasible. During this period, your provider will continue necessary clinical support, offer referrals to other qualified providers, and assist with the transfer of records as requested.

Automatic Discharge

If there has been no clinical contact for one year, you will be automatically discharged from the practice. Re-entry into care is at the provider's clinical discretion and may require a new intake evaluation.

Referrals

Upon termination for any reason, referrals to other providers will be made available upon request.

XIII. Your Rights as a Patient

You have the right to:

  • Receive services in a respectful, professional manner, free from discrimination
  • Be informed about your diagnosis, treatment options, and the risks and benefits of proposed treatments
  • Participate in decisions about your care and ask questions at any time
  • Refuse or withdraw consent for any recommended treatment
  • Access your medical records and request corrections
  • Receive a copy of all documents you sign
  • File a complaint with your provider's licensing board or with the U.S. Department of Health and Human Services Office for Civil Rights (1-800-368-1019)

Licensing board contacts by discipline:

XIV. Changes to this Notice

We reserve the right to revise or change provisions on this Notice. We will implement the new Notice provisions effective for all services provided and confidential information we maintain. The most current version of this notice will be available on our website at https://www.emilywoodmdphd.com/policies. The Notice will contain the effective date on the top of the first page.

XV. Acknowledgment and Agreement

Key points:

  • Payment is due at time of service; a credit card on file is required. All providers are out-of-network — you pay in full and may seek reimbursement from your insurer using a superbill we provide.
  • Confidentiality is protected, with limited legal exceptions (imminent danger to self or others, child/elder abuse reporting, court orders).
  • Emergencies: Do not contact your provider. Call 911, text/call 988, or the LA County Help Line at (800) 854-7771.
  • Cancellations require 48 hours' notice for intakes, 24 hours for all other appointments. First no-show is free; subsequent ones are charged in full. Intakes require a 50% deposit at booking.
  • Communication via Spruce Health or Jane App during business hours only — not for emergencies, not via social media.
  • You have the right to access your records, seek a second opinion, refuse treatment, and end the treatment relationship at any time.

By signing below, I acknowledge that:

  • I have read and understood this document, or it has been read and explained to me.
  • I have had the opportunity to ask questions, and any questions have been answered to my satisfaction.
  • I understand the limits of confidentiality, the communication policies, the cancellation and billing terms, and the terms described above.
  • I agree to the terms of this Shared Practice Policies & Patient Information document.

Patient (or Legal Guardian if patient is a minor)

Signature: ___________________________________________

Date: ___________________________________________

Printed Name: ___________________________________________

Relationship (if signing on patient's behalf): ___________________________________________