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IMPORTANT Forms

Please understand that APNSolutions takes your privacy and confidentiality very seriously and has made every effort to maintain the security of your treatment records. As you are aware, the law protects the relationship between a patient and a psychiatric mental health practitioner and, with few exceptions, information cannot be disclosed without the patient's written permission.  Adolescents age 14 and older have the same right to the privacy and confidentiality of their psychiatric mental health & substance abuse treatment records and must also give written permission for information to be released, even to their parents or guardians.

There are very few scenarios in which a patient's confidentiality and privacy may be broken without the patient's written permission for disclosure.  These exceptions for which a patient's confidentiality and privacy may be broken are listed below:

  • The clinician suspects child abuse or neglect or dependent adult or elder abuse. Under these conditions the law requires that the clinician immediately report the suspicions to the appropriate authorities.
  • If a patient is threatening serious bodily harm to another person/s, by law, the clinician must notify the police and inform the intended victim.
  • If a patient threatens or intends to harm himself or herself, the clinician will make every effort to enlist their cooperation in maintaining their safety. If the patient does not or is not able to cooperate, the law allows the clinician to break confidentiality and privacy in order to take measures to ensure the patient's safety.

The following forms are a review of our confidentiality limitations and HIPAA Privacy Notices. 


If you would like us to coordinate care with another provider (for example: a family member, your previous Psychiatrist or Psychiatric Nurse Practitioner, a therapist, your primary care practitioner, etc.), complete the Release of Information Form by to authorize release of psychotherapy information:

In an effort to improve the safety and security of our citizens and reduce the impact of improper medication disposal on our environment, the New Jersey Division of Consumer Affairs has issued guidelines for the Safe Disposal of Medications.  Please click on the following link to review this important information:

 

 

 

 

Note: To download Adobe Acrobat Reader for free, click here.

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