Zero Tolerance Policy- Violence and Harassment

Our practice is committed to maintaining a safe, respectful, and inclusive work environment for all employees. Harassment and violence of any kind will not be tolerated under any circumstances. We have adopted a zero tolerance policy for harassment and violence in the workplace, and a client will be discharged immediately with the appropriate amount of refills and resources per Kentucky Board of Nursing (BON).

  • Harassment includes, but is not limited to verbal, physical, visual, or psychological conduct that creates an intimidating, hostile, or offensive work environment. This includes sexual harassment, bullying, discriminatory remarks, and any unwanted conduct based on race, gender, religion, age, disability, sexual orientation, or any other protected characteristic. Violence includes any act or threat of physical violence, intimidation, or disruptive behavior. This includes verbal threats, aggressive behavior, physical assaults, or the intentional destructive of property.

Cancellations

Cancellations should be done over 24 hours in advance, and if not a late cancellation/no-show fee will be charged

Patient Initiated Phone Calls

Patient Initiated Phone Calls can be setup via the booking email and are charged immediately after the phone call. We advise you to try to wait to setup an appointment for the following days or later in the week. Always remember that if it an emergency, please call 9-1-1 and seek immediate assistance at the nearest Emergency Department.

Paperwork

The following paperwork fees will be incurred:

  • Disability Paperwork (short form)* — $50

  • Disability Paperwork (medium form)* — $100

  • Disability Paperwork (long form)* — $150

  • Court Hearing/Appearance (4 hrs min) — $500

  • Court Hearing/Appearance (additional 4 hrs) — $500

  • 5–10 min Patient Initiated Phone Call — $15

  • 11–20 min Patient Initiated Phone Call — $25

  • 21–30 min Patient Initiated Phone Call — $50

  • Overdue Balance Fee (Over 30 days) — $50

  • Non-Sufficient Funds Fee — $35

  • Credit Card Chargeback Fee — $50

  • Late Cancellation/No-Show Fee — $75

  • Medical Cannabis Card Evaluation (new patients) — $350

Controlled Substances Policy

Controlled substances carry the risks of dependence, misuse, and diversion. Our goal is to prescribe safely and in your best interests. We strive to ensure that each client fits criteria for controlled substances, thus we have certain guidelines in relation to this, and we will have an agreement on file with our policy. Failure to abide by this policy may result in a change in treatment plan (medication change), and possibly a discharge from the practice following all guidelines by the Kentucky BON.

  • Use medications as prescribed.
  • One prescriber and one pharmacy. If there is any changes, report them immediately (within one week).
  • No early refills or lost medications.
  • Monitoring and compliance, with random urine drug screens (UDS) and checking their KASPER.
  • Follow all guidelines related to controlled substances, which includes more frequent appointments, and in-person appointments at times.

  • BENZOdiazepines
    ○ New client’s first appointments will need to be in-person.
    ○ Client’s medications will need to be re-evaluated on a case-by-case situation, but may need to follow a tapering agreement.
    ○ Client’s in this practice are required to attend mandatory therapy twice a month if they are on BENZO’s.

  • STIMULANTS (ADD/ADHD)
    ○ New client’s first appointments will need to be in-person.
    ○ A baseline EKG may need to be completed for children before stimulants are started.
    ○ A baseline EKG, and cardiac clearance (by PCP or cardiologist) must be obtained before stimulants are started for adults.
    ○ Client’s in this practice are required to attend mandatory therapy twice a month if they are on stimulants.
    ○ Client’s that are children must have a parent present for one additional follow-up session where therapy is conducted.

**The office and fax number can be used for Phone calls, Messaging, and Fax using Spruce, which is HIPAA compliant.
All emails used at this practice are also HIPAA compliant**

Notice of Privacy Practices

Pellman’s Peaceful Practice
Effective Date: September 2, 2025

This Notice of Privacy Practices (“Notice”) describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Our Commitment to Your Privacy

At Pellman’s Peaceful Practice, we are committed to protecting your health information. We are required by law to:

  • Maintain the privacy and security of your protected health information (PHI).

  • Provide you with this Notice explaining our legal duties and privacy practices.

  • Follow the terms of this Notice.

  • Notify you promptly if a breach occurs that may compromise the privacy or security of your information.

How We May Use and Disclose Your Information

We may use or share your PHI in the following ways:

1. For Treatment

To provide, coordinate, or manage your mental health care and related services. For example, sharing PHI with another provider involved in your treatment.

2. For Payment

To bill and collect payment for services. For example, sharing information with your insurance plan to confirm coverage.

3. For Health Care Operations

To run our practice, improve care, and contact you when necessary. Examples include quality assessment, staff training, or accreditation activities.

4. With Your Authorization

Other uses and disclosures not described in this Notice will only occur with your written authorization. You may revoke this authorization at any time, in writing.

5. Special Circumstances (Required or Permitted by Law)

We may also disclose PHI without your authorization in these limited situations:

  • Public health activities (e.g., reporting abuse, neglect, or domestic violence).

  • Judicial and administrative proceedings (in response to a court order or subpoena).

  • Law enforcement purposes (if required by law).

  • Health and safety threats (to prevent serious and imminent harm to yourself or others).

  • National security and government functions.

6. Psychotherapy Notes

Psychotherapy notes receive special protection. They will not be disclosed without your written authorization except when permitted or required by law.

Your Rights Regarding Your Health Information

You have the following rights under HIPAA:

  • Right to Access: You may inspect or receive a copy of your health records.

  • Right to Amend: You may request corrections to your health records if you believe they are incorrect or incomplete.

  • Right to an Accounting of Disclosures: You may ask for a list of certain disclosures we have made of your PHI.

  • Right to Request Restrictions: You may request limits on how your PHI is used or disclosed. While we are not always required to agree, we will comply when legally obligated.

  • Right to Confidential Communications: You may request that we contact you by alternative means or at specific locations.

  • Right to a Paper Copy: You may request a paper copy of this Notice, even if you agreed to receive it electronically.

  • Right to File a Complaint: If you believe your privacy rights have been violated, you can file a complaint with us or with the U.S. Department of Health and Human Services (HHS), Office for Civil Rights. We will not retaliate against you for filing a complaint.

Safeguards We Use to Protect Your Information

We protect your PHI through:

  • Administrative safeguards: Staff training, privacy policies, and internal monitoring.

  • Physical safeguards: Secure offices, restricted access, and locked filing systems.

  • Technical safeguards: Encryption, secure authentication, and HIPAA-compliant communication platforms.

Business Associates

We may share PHI with third-party service providers (e.g., telehealth platforms, billing services, or IT vendors). These business associates are required by HIPAA to protect your information through Business Associate Agreements (BAAs).

Website and Electronic Communications

If you use our website, online forms, or telehealth services, we take steps to ensure your data is protected. All emails at Pellman’s Peaceful Practice are HIPAA compliant. We discourage sharing sensitive health information via unsecured email.

Changes to This Notice

We may change the terms of this Notice at any time. The updated version will apply to all PHI we maintain. The most current Notice will always be available on our website and upon request.

Contact Information

If you have questions about this Notice, or if you wish to exercise your privacy rights, please contact:

Privacy Officer
Pellman’s Peaceful Practice
11909 Shelbyville Rd, Suite 100
Phone: 502-747-1503
Email: help@peacefulpractice.org

You may also contact the:
U.S. Department of Health & Human Services, Office for Civil Rights
Website: https://www.hhs.gov/ocr
Phone: 1-800-368-1019