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CMS References

Patient Rights and Responsibilities

42 CFR § 482.13

HIPAA Privacy Practices

45 CFR § 164.520

Non-Discrimination Policy (ACA Section 1557)

ACA 1557 (42 U.S.C. § 18116)

Grievance and Complaint Process

42 CFR § 482.13(a)(2)

No Surprise Billing Act Notice

No Surprises Act, 2021 (Public Law No. 116-260)

Emergency Instructions

42 CFR § 482.13(c)(2)

ADA Accessibility Notice

Americans with Disabilities Act (ADA) Title III

Interpreter and Language Assistance Notice

Title VI of the Civil Rights Act (1964) and ACA Section 1557

Payment Policy Transparency

CMS Best Practice (42 CFR § 405.2402)

Missed Appointment / Late Cancellation Fee

CMS Best Practice for Transparency

Medication Refill Policy

DEA Controlled Substance Regulations + CMS Medication Management Standards

Telehealth Consent Notice

42 CFR § 410.78

Clinic Behavior Expectations

42 CFR § 482.13(c)(2)

Weapons-Free Workplace Policy

OSHA General Duty Clause Section 5(a)(1)

Clinic Surveillance and Monitoring Notice

HIPAA Security Rule (45 CFR § 164.312)

Spravato and Brain Health Monitoring Notice

FDA REMS + HIPAA Patient Monitoring Standards

1501 S. Ranchwood Blvd, Suite 203, Yukon, OK 73099

Tel: 405-914-6634

Fax: 405-914-6693

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