Doctor of Nursing Practice – A DNP is a clinical practice doctor

Psychiatric Mental Health Nurse Practitioner – Board Certified

Family Nurse Practitioner – Board Certified

Family Nurse Practitioner – Certified

In the clinical setting, these terms are often used interchangeably, to indicate services that are provided remotely using video or telephone conferencing. A Better Outlook Psychiatry & Addiction uses both methods of clinical communication to better serve our clients, but reserves the right to restrict services to in-person visits or video conferencing based on the clinical need.

Please be advised that our office is enforcing our policies on controlled substance prescription management to align with state and federal guidelines. The rapid escalation of diversion and overdoses related to prescription pain (opiate), anxiety (benzodiazepine), and ADHD (stimulant) medications has resulted in a need for heightened caution around the prescription and distribution of these controlled medications. Changes you can anticipate if your prescriptions fall into any of these below categories include; 

1. If you are prescribed any controlled medications, mandatory random Urine Drug Screens a minimum of twice a year. We will be unable to provide a controlled prescription to any patient who will refuse this monitoring requirement. As a friendly reminder to our standing policy, any patients who we require a urine drug screening will have 24 hours to complete the collection.
2. The use of two different benzodiazepine medications is contraindicated and no longer possible. This includes any benzodiazepine- based sleep aids. Any patient who has been receiving two benzodiazepines for any reason, please be aware that we will be working to discontinue one medication and substituting with non-controlled options for safer replacement.
3. The use of opiates and benzodiazepines and/or hypnotic sleep aides together is contraindicated and increases the likelihood of overdose and possible death. We will not continue to co-prescribe an opioid pain medication and a benzodiazepine or hypnotic sleep aide medication. If you are on opiates routinely to manage chronic pain, it will be necessary to taper you off benzodiazepines and/or hypnotic sleep aide.
4. Current guidance on the use of benzodiazepines suggest that these medications only be used in a time limited manner and should not be administered on a chronic basis. Daily, regular use of benzodiazepines for the management of generalized anxiety is not recommended. Use of these medications for the management of panic disorder may be considered, but all efforts will be made to help you to gain control of symptoms with noncontrolled medication options. If you are currently taking a benzodiazepine routinely, we will be talking about noncontrolled options such as SSRI antidepressants, Neurontin, Buspar, Vistaril, TMS Therapy and increased therapy options to manage anxiety. We will be gradually working with you to decrease the amount of benzodiazepines over an appropriate period of time to wean use down to a prn use only.
5. The use of opiates and/or benzodiazepines together with ADHD stimulant medications is contraindicated and increases the likelihood of overdose and possible death. We will not continue to co-prescribe an opioid pain medication and/or benzodiazepine medication together with an ADHD medication. If you are on opiates routinely to manage chronic pain or benzodiazepines and wish to start or continue ADHD stimulant medications then it will be necessary to taper you off of the opiate and/or benzodiazepine prior to starting the stimulant medication.

While we understand these rules can present new challenges, we are confident this is the correct approach clinically and the most appropriate treatment course. While benzodiazepine medications may be effective at short term symptom improvement, the risks of tolerance, dependence, abuse, motor vehicle accident risks, fall risk, cognitive impairment risks, and other risks associated with benzodiazepines outweigh the benefits, and therefore, necessitates monitoring and appropriate prescription management and patient usage. Your care team will discuss with you any questions or concerns that you may have.

Our goal is to assist you in returning to health in a safe manner by minimizing risks associated with medications. 

You are responsible for attending each appointment and agree to adhere to the following policy: If you cannot keep the scheduled appointment, you MUST notify our office to cancel or reschedule the appointment within 24 hours of the scheduled appointment time or you will be charged $200 for New patients and $65 for Established patients, No-show fee for New patients is $200 and $65.00 for Established patients. If you cancel or reschedule more than once, we may re-evaluate your needs, desires, and motivations for treatment at this time.

Prescriptions are written with sufficient refills to last until our next scheduled appointment. Follow-up appointments enable me to make an assessment about the appropriateness and safety of refilling medications. It is your responsibility to schedule an appointment prior to running out of medications. Please do not have your pharmacy put your prescriptions on automatic refill as this results in erroneous requests. New medications are not prescribed, nor are doses increased, over the phone. Refills will not be prescribed for anyone who does not have a scheduled follow-up appointment. 

We check voicemails and messages on the patient portal/spruce app  frequently and attempt to respond within 2 business days. As a solo practitioner, I am unable to provide 24-hour emergency coverage. If you are unable to connect with me and you need to speak with someone right away, please call the North Texas Behavioral Health Authority at (866)-260-8000. In the event of an emergency, call 911 immediately or go to the nearest hospital emergency room. During extended absences, I will leave the phone number of a colleague on my voicemail. I will authorize this individual to access your records in the event they are needed to address an urgent concern that could not have been anticipated. 

I will only suggest time off work after an assessment, and it is deemed necessary. I will not fill out any disability or FMLA paperwork if you have already taken yourself off work on your own or if you have been taken off work by another provider.