Privacy Practices

The following explains how patient Protected Health Information is utilized. Please note that this notice applies once you enroll as a patient. Information transmitted via email is not HIPAA-compliant.

Confidentiality and Patient Rights:

Your health record contains personal information about you and your health. This information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services is referred to as Protected Health Information (“PHI”). This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with applicable law and respective ethical codes of the practitioners in this office. It also describes your rights regarding how you may gain access to and control you PHI. We are required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI. We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of our Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. You may request a copy of the Notice of Privacy Practices at any time.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

For Treatment. Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. This includes consultation with clinical supervisors or other treatment team members. We may disclose PHI to any other consultant only with your authorization. For Payment. We may use and disclose PHI so that we can receive payment for the treatment services provided to you. This will only be done with your authorization. Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities. If it becomes necessary to use collection processes due to lack of payment for services, we will only disclose the minimum amount of PHI necessary for purpose of collection. For Health Care Operations. We may use or disclose, as needed, your PHI in order to support our business activities including, but not limited to, quality assessment activities, employee review activities, licensing, and conducting or arranging for other business activities.

For example, we may share your PHI with third parties that preform various business activities (e.g., billing or typing services) provided we have a written contract with the business that requires it to safeguard the privacy of your PHI. For training or teaching purposes PHI will be disclosed only with your authorization. Required by Law. Under the law, we must make disclosures of your PHI to you upon your request. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of Privacy Rule. Without Authorization.

Applicable law and ethical standards permit us to disclose information about you without your authorization only in a limited number of other situations. The types of uses and disclosures that may be made without your authorization are those that are:
Required by Law, such as the mandatory reporting of child abuse or neglect or mandatory government agency audits or investigations (such as a licensing board or the health department).

Required by Court Order

Necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.

Verbal Permission

We may use or disclose your information to family members that are directly involved in your treatment with your verbal permission.

YOUR RIGHTS REGARDING YOUR PHI

You have the following rights regarding PHI we maintain about you. To exercise any of these rights, please submit your request in writing to Skycloud Mental Health at 818 SW 3rd Ave #221-5258, Portland, OR, 97204

Right of Access to Inspect and Copy.

You have the right, which may be restricted only in exceptional circumstances, to inspect and copy PHI that may be used to make decisions about your care. Your right to inspect and copy PHI will be restricted only in those situations where there is compelling evidence that access would cause serious harm to you. We may charge a reasonable, cost-based fee for copies.

Right to Amend.

If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information although we are not required to agree to the amendment.

Right to an Accounting of Disclosure.

You have the right to request an accounting of certain of the disclosures that we make of your PHI. We may charge you a reasonable fee if you request more than one accounting in any 12-month period.

Right to Request Restrictions.

You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. We are not required to agree to your request.

Right to Request Confidential Communication.

You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.

Right to a Copy of this Notice.

You have the right to a copy of this notice.

Complaints

If you believe we have violated your privacy rights, you have the right to file a complaint in writing to Skycloud Mental Health at 818 SW 3rd Ave #221-5258, Portland, Oregon 97204 or by calling 503-694-3381. Additionally, you may issue a complaint with the Secretary of Health and Human Services at 200 Independence Avenue. S.W. Washington, D.C. 20201 or by calling (202) 619-0257. We will not retaliate against you for filing a complaint.

    Holistic Psychiatric Treatment
    at Home in OR, WA, UT, MN, AZ, and NM

    Evidence-based mental

    healthcare at Skycloud

    Get Started

    Do you prefer to register online or by phone?

    The following questions will match you with the provider best suited to your needs. Are you the patient?

    The potential patient, or their parent/guardian, must fill out this form. Identification will be requested during the process. If they are not available, please direct the potential patient to this page at a later time. Health care providers can find referral information here.

    We are taking patients ages 13-17 with certain specified insurance panels in OR and WA, and patients 16-17 with a referral in UT. “You” in the following slides refers to the potential patient.

    Are you seeking psychotherapy, medication management, or another evaluation type?

    Our psychotherapy caseload is full. Click here to learn more about psychiatric evaluations, which can help you determine a treatment plan. Call us at 503-694-3391 or email admin@skycloudhealth.com with any questions.

    Our psychotherapy caseload is full. Click here to learn more about psychiatric evaluations, which can help you determine a treatment plan. Call us at 503-694-3391 or email admin@skycloudhealth.com with any questions.

    Limitations of Skycloud:

    • – We do not offer emotional support animal letters.
    • – We do not offer evaluations for disability or legal reasons.
    • – We do not accept Medicare or Medicaid.
    • – We do not provide work or academic accommodations. We can provide a diagnosis letter in the context of ongoing psychiatric care.
    Resources

    Have you attempted suicide in the past?

    When was your most recent suicide attempt?

    Unfortunately we do not have clinicians who are able to treat you via telehealth at this time. Please contact clinic at (503) 694-3381 with questions and check our list of resources.

    Have you ever been hospitalized in a psychiatric unit or stayed in a residential mental health facility?

    When was your most recent hospitalization or stay in a residential mental health facility?

    Where do you reside?

    We are only offering services in Oregon, Washington, Utah, New Mexico, Arizona, and Minnesota at this time.

    Are you currently prescribed a stimulant (e.g. Adderall, Ritalin) or benzodiazepine (e.g. Ativan, Xanax) and seeking to continue it?

    Are you currently prescribed a stimulant (e.g. Adderall, Ritalin) or benzodiazepine (e.g. Ativan, Xanax) and seeking to continue it?

    Are you currently prescribed a stimulant (e.g. Adderall, Ritalin) or benzodiazepine (e.g. Ativan, Xanax) and seeking to continue it?

    Are you currently prescribed a stimulant (e.g. Adderall, Ritalin) or benzodiazepine (e.g. Ativan, Xanax) and seeking to continue it?

    We prescribe controlled substance medications (i.e. stimulants, benzodiazepines) only to patients in OR and WA with a required minimum once yearly in-office visit in Clackamas, OR when clinically appropriate (please view our stimulant policy). It may be helpful to note that in our practice, we rarely use benzodiazepines (e.g. Xanax, Ativan, Klonopin). Contact admin@skycloudhealth.com with questions.

    In-office visits are required once a year in Clackamas, OR for patients who are prescribed controlled substances. Click “Okay” to continue.

    We prescribe controlled substance medications (i.e. stimulants, benzodiazepines) only to patients in OR and WA with a required minimum once yearly in-office visit in Clackamas, OR when clinically appropriate (please view our stimulant policy). It may be helpful to note that in our practice, we rarely use benzodiazepines (e.g. Xanax, Ativan, Klonopin). Contact admin@skycloudhealth.com with questions.

    In-office visits are required once a year in Clackamas, OR for patients who are prescribed controlled substances. Click “Okay” to continue.

     

     

    We do not prescribe stimulant, benzodiazepines, Suboxone, or other controlled substances in Minnesota. If you would still like to schedule, click Okay. To see other Resources, click “Resources.”

    We do not prescribe stimulant, benzodiazepines, Suboxone, or other controlled substances in Utah. If you would still like to schedule, click Okay. To see other Resources, click “Resources.”

    Which insurance plan do you have?

    Which insurance plan do you have?

    Which insurance plan do you have?

    Which insurance plan do you have?

    Which insurance plan do you have?

    Which insurance plan do you have?

    If your insurance was not listed, we may not be in your network. Please email billing@skycloudhealth.com to verify.

    If your insurance was not listed, we may not be in your network. Please email billing@skycloudhealth.com to verify.

    How old are you?

    We do not have providers serving people under 18 at this time who accept your insurance. Email us for temporary self-pay options while our pediatric providers are in the credentialing process. Here is a list of resources.

    Due to federal laws that prevent us from seeing patients who are qualified for Medicare as self-pay patients without opting out of Medicare, we are unable to see patients who are over 65 at this time. Here is a list of resources.

    How old are you?

    We do not have providers serving people under the age of 13 at this time. Here is a list of resources.

    Due to federal laws that prevent us from seeing patients who are qualified for Medicare as self-pay patients without opting out of Medicare, we are unable to see patients who are over 65 at this time. Here is a list of resources.

    How old are you?

    We do not have providers serving people under the age of 13 at this time. Here is a list of resources.

    Due to federal laws that prevent us from seeing patients who are qualified for Medicare as self-pay patients without opting out of Medicare, we are unable to see patients who are over 65 at this time. Here is a list of resources.

    How old are you?

    We do not have providers serving people under the age of 13 at this time. Here is a list of resources.

    Due to federal laws that prevent us from seeing patients who are qualified for Medicare as self-pay patients without opting out of Medicare, we are unable to see patients who are over 65 at this time. Here is a list of resources.

    Our provider is in process of panelling with your insurance. You can see him at a discounted self pay rate until he is contracted. Click below to schedule.

    Resources

    Registration forms must be completed within 24 hours of booking or appointment will be cancelled. Forms take 15-20 minutes to complete. Please have your payment method, state ID and insurance card available.

    We offer a limited amount of in-office intake appointments in Clackamas, OR (Tuesdays). If you do not see this as an option, you can register as a patient and then email admin@skycloudhealth.com to change your appointment.

    *All times are in Pacific Standard Time (PST).

    Schedule Appointment

    Registration forms must be completed within 24 hours of booking or appointment will be cancelled. Forms take 15-20 minutes to complete. Please have your payment method, state ID and insurance card available.

    We offer a limited amount of in-office intake appointments in Clackamas, OR (Tuesdays). If you do not see this as an option, you can register as a patient and then email admin@skycloudhealth.com to change your appointment.

    *Note: All times are in Pacific Standard Time (PST).

    Dose/Med

    Our providers will review your submission to determine if we are a good fit for your needs. Please submit the following required information for the potential patient (yourself or your child): insurance, age, current medications names and dosages. If the potential patient is taking a benzodiazepine, specify if they are looking to taper off of the medication. If the potential patient is a minor, please specify whether or not they have a history of self-harm. *It may be helpful to note that in our practice, we rarely use benzodiazepines (e.g., Ativan, Xanax, Klonopin).

    Name(Required)
    Name(Required)

    Med/Dose

    Our providers will review your submission to determine if we are a good fit for your needs. Please submit the following required information for the potential patient (yourself or your child): insurance, age, current medications names and dosages. If the potential patient is taking a benzodiazepine, specify if they are looking to taper off of the medication. If the potential patient is a minor, please specify whether or not they have a history of self-harm. *It may be helpful to note that in our practice, we rarely use benzodiazepines (e.g., Ativan, Xanax, Klonopin).

    Name(Required)
    Name(Required)

    Are you currently prescribed a stimulant (e.g. Adderall, Ritalin) or benzodiazepine (e.g. Ativan, Xanax) and seeking to continue it?

    We do not prescribe stimulant, benzodiazepines, Suboxone, or other controlled substances in Arizona. If you would still like to schedule, click Okay. To see other Resources, click “Resources.”

    Which insurance plan do you have?

    If your insurance was not listed, we may not be in your network. Please email billing@skycloudhealth.com to verify.

    We are accepting self-pay patients for psychotherapy in Oregon and Utah. Our provider is in process of credentialing with several insurances. We have a waitlist for clients in Washington.

     

    Resources

    Psychotherapy Consultation (OR and UT)

    We are accepting PacificSource, Aetna and self-pay patients for psychotherapy in Oregon and Utah. Our provider, Nat Day LCSW, is also in process of credentialing with other insurance panels - Cigna, BCBS, and Moda. Please provide your contact information for a 15 minute free consultation phone call.

    Name(Required)

    Psychotherapy Waitlist

    Our psychotherapy waitlist is open for patients located in Oregon and Washington with Cigna, Aetna, PacificSource, BCBS, and Moda, and self-pay pay sources only. Our psychotherapy providers treat ages 18-64. This waitlist is currently 6-12 months out, depending on age, state and insurance. Please provide the information requested below. Note: do not use this form in an emergency.

    Name(Required)
    Name(Required)

    Los formularios de registración deben completarse dentro de las 24 horas posteriores a la reserva o la cita será cancelada. Los formularios tardan entre 15 y 20 minutos en completarse. Tenga a mano su método de pago, identificación estatal y tarjeta de seguro médico.

    *Todos los horarios están en hora estándar del Pacífico (PST).

    Proceed with online registration or by phone?

    Phone Number: (503) 694-3381

    Phone Hours: 3:00pm-6:30pm (PT) TWTh / 11am-2pm (PT) Sat and Sun

    Phone Registration

    Register below for a phone call, or call our office number (503) 694-3381 ext. 2 to register during the hours listed below.

    Must be a legal guardian of the potential patient.

    Thanks for submitting this form! We will contact you during the specified times.

    How old are you?

    We do not have providers serving people under the age of 13 at this time. Here is a list of resources.

    Due to federal laws that prevent us from seeing patients who are qualified for Medicare as self-pay patients without opting out of Medicare, we are unable to see patients who are over 65 at this time. Here is a list of resources.

    Registration forms must be completed within 24 hours of booking or appointment will be cancelled. Forms take 15-20 minutes to complete. Please have your payment method, state ID and insurance card available.

    We offer a limited amount of in-office intake appointments in Clackamas, OR (Tuesdays). If you do not see this as an option, you can register as a patient and then email admin@skycloudhealth.com to change your appointment.

    *Note: All times are in Pacific Standard Time (PST).

    How old are you?

    We do not have providers serving people under the age of 13 at this time. Here is a list of resources.

    Due to federal laws that prevent us from seeing patients who are qualified for Medicare as self-pay patients without opting out of Medicare, we are unable to see patients who are over 65 at this time. Here is a list of resources.

    Registration forms must be completed within 24 hours of booking or appointment will be cancelled. Forms take 15-20 minutes to complete. Please have your payment method, state ID and insurance card available.

    We offer a limited amount of in-office intake appointments in Clackamas, OR (Tuesdays). If you do not see this as an option, you can register as a patient and then email admin@skycloudhealth.com to change your appointment.

    *All times are in Pacific Standard Time (PST).

    Schedule Appointment

    Are you currently prescribed a stimulant (e.g. Adderall, Ritalin) or benzodiazepine (e.g. Ativan, Xanax) and seeking to continue it?

    We do not prescribe stimulant, benzodiazepines, Suboxone, or other controlled substances in New Mexico. If you would still like to schedule, click Okay. To see other Resources, click “Resources.”

    Which insurance plan do you have?

    If your insurance was not listed, we may not be in your network. Please email billing@skycloudhealth.com to verify.

    How old are you?

    We do not have providers serving people under the age of 13 at this time. Here is a list of resources.

    Due to federal laws that prevent us from seeing patients who are qualified for Medicare as self-pay patients without opting out of Medicare, we are unable to see patients who are over 65 at this time. Here is a list of resources.

    Registration forms must be completed within 24 hours of booking or appointment will be cancelled. Forms take 15-20 minutes to complete. Please have your payment method, state ID and insurance card available.

    We offer a limited amount of in-office intake appointments in Clackamas, OR (Tuesdays). If you do not see this as an option, you can register as a patient and then email admin@skycloudhealth.com to change your appointment.

    *All times are in Pacific Standard Time (PST).

    How old are you?

    We do not have providers serving people under the age of 13 at this time. Here is a list of resources.

    Due to federal laws that prevent us from seeing patients who are qualified for Medicare as self-pay patients without opting out of Medicare, we are unable to see patients who are over 65 at this time. Here is a list of resources.

    How old are you?

    We do not have providers serving people under the age of 13 at this time. Here is a list of resources.

    Due to federal laws that prevent us from seeing patients who are qualified for Medicare as self-pay patients without opting out of Medicare, we are unable to see patients who are over 65 at this time. Here is a list of resources.

    How old are you?

    We do not have providers serving people under the age of 13 at this time. Here is a list of resources.

    Due to federal laws that prevent us from seeing patients who are qualified for Medicare as self-pay patients without opting out of Medicare, we are unable to see patients who are over 65 at this time. Here is a list of resources.

    How old are you?

    We do not have providers serving people under the age of 13 at this time. Here is a list of resources.

    Due to federal laws that prevent us from seeing patients who are qualified for Medicare as self-pay patients without opting out of Medicare, we are unable to see patients who are over 65 at this time. Here is a list of resources.

    Registration forms must be completed within 24 hours of booking or appointment will be cancelled. Forms take 15-20 minutes to complete. Please have your payment method, state ID and insurance card available.

    We offer a limited amount of in-office intake appointments in Clackamas, OR (Tuesdays). If you do not see this as an option, you can register as a patient and then email admin@skycloudhealth.com to change your appointment.

    *Note: All times are in Pacific Standard Time (PST).

    Registration forms must be completed within 24 hours of booking or appointment will be cancelled. Forms take 15-20 minutes to complete. Please have your payment method, state ID and insurance card available.

    We offer a limited amount of in-office intake appointments in Clackamas, OR (Tuesdays). If you do not see this as an option, you can register as a patient and then email admin@skycloudhealth.com to change your appointment.

    *All times are in Pacific Standard Time (PST).

    Registration forms must be completed within 24 hours of booking or appointment will be cancelled. Forms take 15-20 minutes to complete. Please have your payment method, state ID and insurance card available.

    We offer a limited amount of in-office intake appointments in Clackamas, OR (Tuesdays). If you do not see this as an option, you can register as a patient and then email admin@skycloudhealth.com to change your appointment.

    *All times are in Pacific Standard Time (PST).

    Registration forms must be completed within 24 hours of booking or appointment will be cancelled. Forms take 15-20 minutes to complete. Please have your payment method, state ID and insurance card available.

    We offer a limited amount of in-office intake appointments in Clackamas, OR (Tuesdays). If you do not see this as an option, you can register as a patient and then email admin@skycloudhealth.com to change your appointment.

    *All times are in Pacific Standard Time (PST).

    Registration forms must be completed within 24 hours of booking or appointment will be cancelled. Forms take 15-20 minutes to complete. Please have your payment method, state ID and insurance card available.

    We offer a limited amount of in-office intake appointments in Clackamas, OR (Tuesdays). If you do not see this as an option, you can register as a patient and then email admin@skycloudhealth.com to change your appointment.

    *All times are in Pacific Standard Time (PST).

    Registration forms must be completed within 24 hours of booking or appointment will be cancelled. Forms take 15-20 minutes to complete. Please have your payment method, state ID and insurance card available.

    We offer a limited amount of in-office intake appointments in Clackamas, OR (Tuesdays). If you do not see this as an option, you can register as a patient and then email admin@skycloudhealth.com to change your appointment.

    *All times are in Pacific Standard Time (PST).

    Your information is kept confidential and helps us ensure we can provide you with care. Assistance: admin@skycloudhealth.com

    If you are in a mental health crisis, do not use this form, call 988.