Open Notes Disclaimer

Last Updated: January 27, 2025 

Please read this document in its entirety before reviewing any progress notes provided to you. This document contains important information and context to assist you in understanding your progress notes. Reviewing progress notes is not a substitute for professional medical opinions, nor does it replace the need for one-on-one appointments (in person or via).

EMERGENCIES

  • If you have strong suicidal thoughts, or if you are experiencing thoughts, emotions, or behaviors that may put yourself or others in danger of harm, please go to the nearest ER or call 9-1-1, then contact me. Please note that, depending on the circumstances, I may not be able to get back to you immediately.

  • If you or someone you know is struggling or in crisis, help is available. Call or text 988​, or chat @ 988lifeline.org. 

INTRODUCTION

Your Progress Notes are being provided to you in compliance with the 21st Century Cures Act. The Cures Act implements what is known as “OpenNotes,” the health data philosophy that all patients should have access to the notes their clinicians take during health encounters.  This fact sheet is intended to provide you with some context and information to help you understand your Progress Notes.  Please remember that reviewing Progress Notes is not a substitute for actual treatment.

INFORMED CONSENT TO TREATMENT PLAN

At the beginning of our time together, you verbally acknowledged your understanding of and consent to a mutually developed treatment plan. 

Our continued collaboration requires ongoing mutual agreement on a treatment plan. If we are unable to agree on a treatment plan, it may be appropriate to reconsider the therapeutic value of our collaboration. 

RISKS, BENEFITS, AND ALTERNATIVES WERE DISCUSSED

Prior to prescribing medication, we will take the following steps:

  • I provided you with education on risks, benefits, side effects, and alternatives to medications, including taking no medications at all. You reflected an understanding of this.

  • I advised you of possible medication interactions, which you acknowledged. 

  • Off-Label Use: In some cases, the medications we discussed or prescribed may not have been FDA-approved for the condition(s) we are treating. This “off-label” use is nonetheless guided by scientific literature and clinical judgment. Any off-label use was explained to you, and if applicable, you indicated your understanding.

  • Information on the Use of Psychedelics as Therapeutics. While discussing risks, benefits, and alternatives, I may have shared information regarding research on the use of certain Schedule I (illegal) drugs as therapeutics (e.g., MDMA for PTSD and psilocybin for depression). The goal behind sharing such information is to instill hope where psychopharmacotherapeutics and other interventions have not led to the remission of symptoms. The sharing of such information is not and should not be regarded as an endorsement of the use of Schedule I substances, except as part of FDA-approved clinical trials. I do not provide information on or referrals to “underground” (illegal) psychedelic services.​ 

ALCOHOL, CANNABIS, AND OTHER UNPRESCRIBED MIND-ALTERING SUBSTANCES

Most, if not all, medications I prescribe can be considered “psychotropic” in nature, meaning that their intent is to affect a person’s mental state.

  • As a general rule, I strongly recommend that you avoid or limit the use of alcohol and any unprescribed mind-altering substances while taking psychotropic medication. 

  • It is essential that you completely avoid cannabis while taking psychotropic medication. 

FOLLOW UP / CONTINUATION OF CARE

  • Non-Crisis: You understand that you can contact me between appointments and schedule follow-up appointments through the portal (https://cmbh.intakeq.com/portal). I will make my best efforts to respond within 48 business hours, but this may not always be the case. 

  • Crisis: You agree to call 9-1-1 or go to the nearest ER for any medical or psychiatric emergency. You understand that I am not always available on short notice. 

RECOMMENDATIONS REGARDING COVID-19 

  • I recommend following your state's COVID-19 Guidelines at safestrongoregon.org (Oregon) or covid19.ca.gov (California).

  • Please do not take stimulant medications if you develop COVID-19 symptoms. 

  • LONG COVID SYMPTOMS. If you have tested positive for COVID-19 and begin to or continue to experience chronic fatigue, brain fog, muscle and nerve pain, depression, headache, dizziness, palpitations​, or other possible symptoms of long-term COVID-19, I recommend making an intake appointment with a Long-Term COVID clinic in your community. I am happy to continue caring for you and coordinating your care with experts in this fast-moving and emerging field. Please feel free to share your Progress Notes with the providers there. 

CONTROLLED MEDICATIONS (E.G. STIMULANTS, BENZODIAZEPINES) 

  • LOST OR MISPLACED

    • If controlled medication(s) are prescribed, please know that if you lose or misplace them, I will not write another prescription for it without a police report AND an appointment. To request an early refill on account of lost or misplaced controlled medications, please: 

  • If controlled medication(s) are considered or prescribed, I have consulted with (or will consult with before prescribing): 

    • (Oregon) Oregon Prescription Drug Monitoring Program (PDMP), in accordance with Oregon Administrative Rules 333-023-0800 through 333-023-0830, respectively, and/or​

    • (California) the Controlled Substance Utilization Review and Evaluation System (CURES) in accordance with California Health and Safety Code 11165.4.

  • I will only prescribe controlled medications when I determine, in my professional opinion, that they are appropriate and may benefit you, the patient.

If I know or suspect that a client is “doctor shopping” or otherwise attempting to use my services to misuse or abuse controlled medications, I reserve the right to terminate that client immediately.

TOTALITY OF CHART

  • The Progress Note is partly written to satisfy insurance documentation requirements. Please note that information requiring sensitive handling, such as HIV test results, genetic information, and psychotherapy notes may be stored elsewhere in your medical records and not here. My general policy is to exclude information that, in my professional opinion, has the potential to cause harm (such as details of traumatic memories); this type of information will be stored in the "sensitive handling" area of your medical records instead of in Progress Notes. 

  • Psychotherapy notes are considered my process notes and will not be shared with anyone to ensure therapeutic alliance. 

ERRORS AND OMISSIONS

  • While I will do my best, I am human, and errors and omissions are to be expected. 

  • If and when you spot errors and omissions and/or have comments, questions, disagreements, and/or feedback, please get in touch with me in the Portal. 

  • Once locked, I cannot alter the Note but can append addendums and amendments as necessary. 

SIDE EFFECTS OF OPEN NOTES SHARING

  • As with all therapeutic interventions, there are relatively rare and potentially serious "side effects" from reading your Progress Notes. These include:

    • Anxiety, feelings of overwhelm, flooding, confusion, and/or negative feelings triggered by certain content;

    • Misunderstandings, disagreements, anger;

    • Sadness, hopelessness, suicidal thoughts, and

    • Loss of trust and alliance with the provider due to perceived slights that may have been unintentional and/or erroneously entered on the provider's part.

  • If you experience any of these or other side effects, please (1) stop reading the Progress Notes, and (2) bring this to my attention at our next session or communicate in the Portal if it cannot wait. 

Disclaimer: This website does not provide medical advice, nor does it establish any patient-provider relationship. The information, including but not limited to text, graphics, images, and other material on this website, is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis, or treatment. Speak with me or another qualified healthcare provider if you have any questions regarding a medical condition or treatment before starting a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website.