PASSNJ New Policy and Procedures

PASSNJ-Policy and Procedures: Contract for Safety (6/01/2018)

Overview: Contained are the policy and procedures of Psychiatric and Addiction Services of Southern New Jersey (PASSNJ). Please review them carefully. We have put them in place to ensure that your treatment is safe and that this treatment facility can continue to viably function. If you have any questions discuss them with your doctor or the staff.
Treatment Procedure: PASSNJ provides mental health care, substance abuse treatment, health care, evaluations and other treatments. At any given time we may have on our staff: Psychiatrists, Psychologists, Social Workers, Nurses, Licensed Professional Counselors and other support staff. Psychiatric or Substance Treatment initial evaluations may take approximately 30-60 minutes depending on complexity. Medication management follow up visits can take 10-30 minutes. Counseling with medication management done by a physician can take 30-45 minutes. Psychotherapy or counseling sessions generally take 45 minutes. Counseling and/or Narcotics Anonymous or Alcoholics Anonymous is advised for all patients who present for medication monitoring, substance use treatment, or buprenorphine (Suboxone/Zubsolv/Bunavail/Butrans/etc.) treatment.
Policy for Payment: The patient or their family is responsible for payment of treatment. Payment is due at the time of service. We accept credit cards, bank checks or cash. Personal checks are accepted after the fourth visit. We are unable to accept health insurance at this time. Many health insurers offer a percentage of reimbursement for services from out of network providers. Please call your health insurance for information. We reserve the right to add reasonable additional fees for collections, delay of payment or bounced checks. We are not paneled with Medicare or Medicaid and will not receive any reimbursement from them if you decide to apply.
Missed Appointments: Appointments must be changed or cancelled within 24 business hours of your appointment time or a charge will be incurred (Mondays appointments must be cancelled by Friday). Any appointment cancelled with less than 24 hours notice with the psychiatrist or clinical nurse specialist will be billed $45. Therapy sessions with a counselor or therapist must be cancelled 48 business hours in advance or a charge will be incurred (Monday’s appointment’s must be cancelled by Thursday). Any therapy/counseling session that is missed will be billed at the full rate unless the time can be filled in this short notice.


Lateness: Please be on time or early for your appointment. We make every attempt to run on schedule though this is sometimes difficult. Try to get appointments early if you need to be out quickly. We will attempt to see you if you are late but you may have to wait. We do have patients come in for emergencies. This can sometimes slow things down. Try to be patient; the next emergency that we need to squeeze in might be yours.


Work, School, Agency, Court or Other One-Time Ordered Evaluations: If you are here for a one time evaluation and we have not scheduled a follow-up appointment for treatment or initiated a treatment plan then you are not part of our clinical practice and we are not treating you. You are not our patient. If you have a psychiatric emergency or need psychiatric care you will need to call for an appointment for treatment with either myself or another psychiatrist. At that point you would be considered our patient and under our care. All work, school, agency, court or other one-time ordered evaluations and all pertinent and relevant documentation is directly released to the contracting agency and is secured by them. If you want a copy you’re advised to request it from the agency.


Paperwork, legal and disability forms: Long Term Disability forms will only be done after you’ve been actively treated in our practice for a period of six months or longer. This ensures we understand your case. If you have paperwork such as temporary disability forms that needs to be done, hand them to the clinician at the start of the session. If there is extensive paperwork such as permanent disability that requires letters, phone calls to lawyers, employers or others there may additional charges.


Emergencies: There is an emergency number on the PASSNJ phone message line for evening and weekends. Please use it if you have an emergency such as a medication reaction or suicidal or homicidal behavior. Call the office number for appointments, non-urgent matters and during business hours. If you cannot get a response from the emergency number in a timely fashion please go to the nearest emergency room.

Confidentiality: We make every effort to maintain your confidentiality. We cannot release information without your consent unless: 1) it is a medical emergency, 2) you are going to hurt yourself or someone else, 3) a child is being abused, or 4) a court order.
Adolescent Confidentiality Ages 14-17: Adolescents are entitled to the same confidentiality as adults. If your adolescent tells us something, that they do not want you to know, we cannot reveal this information unless they are in imminent risk of suicide or are homicidal. This means if your child is skipping school, using drugs, pregnant or doing other actions that may not be good for them we cannot tell you this without their permission. Adolescents are at a higher risk for suicide; please watch your child carefully. Secure all medications in the house and any other objects that can be used to hurt themselves. Watch them closely if their behavior is odd or different. If we believe your child is at imminent risk to himself or herself, we may advise inpatient treatment. You must monitor your child/adolescent carefully.
Phone Calls: We make every attempt to return all calls within 24 hours. If you have an emergency let the person answering the phone know and we will return it ASAP. If you cannot get through to our main number use the emergency number on the answering machine or go to the nearest Emergency Room.
Policy for Medications:
  • Please secure your medications!!! Keep medications securely locked. Make every effort not to lose your medications. Do not share them with friends or family members; they are for your use only. We will question any loss of a controlled substance for abuse potential or diversion. We have the right to discharge anyone we believe has done something reckless with his or her medication.
  • The sale or distribution of your meds to another party is criminal activity. This will result in dismissal from treatment.
  • Do not alter your prescriptions or misrepresent yourself to the pharmacy. This may be a criminal offense and will result in dismissal from treatment.
  • Please make sure you have an appointment in advance of running out of medication. We are closed Fridays, weekends and holidays. We do not phone in controlled medication prescriptions. We will authorize at most a one-week refill of non-controlled medications over the phone. You will need to come in within that time frame for a follow up visit.
  • Medications and alcohol: If you are on medication you must avoid alcohol. Alcohol and medication do not mix at all.
  • Medication and drug use: Do not use drugs at all. If you are on psychiatric medication avoid all drug use.
  • Please exercise caution while driving especially if you have started on new medications or have a recent dose adjustment, they can be sedating. When in doubt don’t drive or operate heavy machinery at all and call your doctor.
  • If you are traveling with your medicines keep them in each of their own labeled pharmacy bottles. Law enforcement can arrest you, and they have, or confiscate your medications if you have loose or unlabeled medications on your person.
  • Do not eat foods with poppy seeds in them such as poppy seed bagels. Urine will show opiates.
  • We will review important possible side effects of medications with you when medication is started, increased or at your request. Review the information given with your medications at the pharmacy and speak with the pharmacist as well. If you have questions you need answered after hours please call. By entering into treatment and signing this document you understand that medication may be used in your treatment, that there may be side effects and that you agree to call us if you have any problems with your medications.
  • Pregnancy and Medication: If you are of childbearing age and want to avoid pregnancy please use contraception. Let us know if you are planning a pregnancy so we can advise you about your medications. If you get pregnant while on medication let us know as soon as possible so we can advise you about treatment options during pregnancy.
Buprenorphine Maintenance (Suboxone, Zubsolv, Butrans Bunavail, etc.): Patients on buprenorphine maintenance must be seen monthly (and weekly in at least the first four weeks). If you stop coming for treatment and would like to return, you may be readmitted provided there is an open slot available for you. Do not take other narcotics or intoxicants while on buprenorphine products. Do not share or sell your medications. This is cause for dismissal from treatment. Buprenorphine products are never phoned in; therefore do not run out of medication. Make sure you come to your scheduled appointments. Counseling is advised with all substance use treatment in addition to counseling provided to you by your physician. NA or AA meetings are also advised and there is no charge for these meetings. Whereas counseling is advised, it is not mandated; however your insurer may not pay for your prescription medication without documentation of counseling or sober support groups like NA or AA. Please request documentation of attendance at these meetings for the clinical record if we need to do authorization for your medication. Urine drug screening is done a minimum of 8 times a year. There may be extra fees associated with this from the labs in which this is done. PASSNJ does not charge a fee for any of their expenses associated with urine testing.


Suicidal/Homicidal Behavior: There are recent studies showing an association between the use of antidepressant medications and increased incidence of suicidal behavior. This is low probability but possible. This usually occurs when the meds are initiated or changed. You are more likely to attempt suicide if your depression is untreated than if you take an antidepressant. Please maintain yourself or your family member in safety at all times. Do not hurt yourself or anyone else. Please call the doctor if you cannot maintain safety for yourself or your family member or go to the nearest emergency room. The first few weeks of treatment are the riskiest in terms of attempts at suicide. Adolescents are at a higher risk. Watch them carefully and secure all medications. We advise restricting access to all firearms, weapons, medications or anything that may be used to commit suicide or homicide. If you are having homicidal thoughts please take no aggressive, violent, hostile or homicidal actions against any group or individual and let your doctor know or go to the nearest hospital emergency department.


Firearm Safety: If you or anyone in your household is an owner of a firearm we advise properly storing them as per the legal requirements of the state you live in or federal regulations. If you or anyone in your home is suicidal, homicidal or unpredictable then having firearms in the home is ill advised and we suggest moving them ASAP from the household according to state law or federal regulations. We suggest obtaining appropriate legal counsel when dealing with laws surrounding the ownership, handling and transport of firearms. Please consult with your doctor if you believe this is an issue.

Drugs and Alcohol: Psychiatric medications do not mix with drugs, including marijuana or alcohol. Please do not use them. The combination will impair your ability to function. Do not drive while under the influence of any substance. Do not show up for your appointments intoxicated. Counseling, Narcotics Anonymous, or Alcoholics Anonymous meetings are recommended for anyone with a substance use issue (also see above).



Marijuana is still illegal in New Jersey. Unless you have been medically approved for medicinal marijuana we advise against the use of it. Inhaling smoke is not good for you and there are intoxication syndromes and long-term effects of the use of this drug.


Threatening Behavior, and Politeness: Our staff is generally polite, please extend the same courtesy. Please respect the premises. This office is equipped with cameras and panic buttons. We take threats very seriously. The police will be contacted if staff feels threatened. We will file charges if assaulted or physically or verbally threatened. If you feel uncomfortable while waiting because of another client please let our staff know and we will remedy the situation.

Issues with PASSNJ: Please let us know if you’re having any problems with any of our staff or treatment. We will do our best to remedy the situation. Socializing or conducting business with any of the staff/doctors is impermissible. Please notify one of the doctors/staff if this is a concern. In a practice such as this the physician has full license to speak forcefully or even yell at a patient in the course of treatment. This is generally in the interest of patient safety and therapeutics. He can also use profane language as needed. This might be in a diagnostic or therapeutic fashion. Some patients respond to this when other techniques fall short. This practice has real life adult situations, which sometimes call for real life adult responses and treatment. Dr. Baruch has background in multiple psychotherapeutic techniques and will employ what is necessary in the moment.


Racism, Sexism or Prejudicial Behavior

This facility and the staff do not condone racism, sexism or any type of prejudicial behavior by anyone at any time. If you encounter any of these in our office please notify one of the doctors or staff who will address this quickly. If there is a problem with your doctor, another staff is available to address your concerns. Patients who act in a racist, sexist or prejudicial fashion that interferes with anyone’s treatment or the safe functioning of this office will be discharged from treatment.


Primary Gains, Secondary Gains and Discharge From Treatment

People who come here for treatment come for what’s called “Primary Gains”; they want help and they get help. People who come here for other reasons are here for what’s called “Secondary Gains”; they have a secret or hidden agenda. An example of secondary gains would be: looking to get medication to sell as a profit motive, or to trade for street drugs. This is cause for discharge. We only need to suspect that treatment medication is being sold or redirected in order to discharge someone; we do not need hard evidence, clinical suspicion is enough.


Working With Law Enforcement Undercover

We encourage following the law and maintaining good relationship with local law enforcement. Patients are often approached by law enforcement to take part in “a sting operation” or “set up” the doctor. Usually they do it to mitigate sentencing in some criminal activity they’ve been arrested for. The belief is this will eliminate or lessen their sentencing or the crime. Sometimes they’re threatened to do so. Patients are generally of free will and can do as they choose, however if in the process of working undercover the patient becomes: hostile, threatening, destructive, disruptive to the practice, destructive to the doctor, staff or the care of other patients they will be discharged. The patient working undercover may or may not be here for actual treatment (primary gains) but rather here for secondary gains such as mitigating sentencing against themselves or others (see above). We have the right to discharge anyone here for secondary gains and not for treatment. This is a treatment facility. You must be here for treatment. If you are arrested and or approached by law enforcement to work for them it is advisable you consider legal counsel and weigh your options.



The doctor has the right to discharge the patient at any time. Patients who find themselves discharged are generally purposefully disruptive or violating the rules of this practice such as selling their medication. If discharged you will receive instructions about follow up, your records and emergency care. Some people feel being discharged is license to cause damage to the premises. It is not! It is advised to refrain from any destructive behavior and follow the law.

Consent for Treatment (All Patients Read and Sign):

By signing this I acknowledge that I have read the above materials and I or my family member consent to evaluation and/or treatment with the staff of Psychiatric and Addiction Services of Southern New Jersey. I agree to follow the above policies for evaluation and/or treatment and payment.

______________________       ______________________________       _________

Patient Signature                       Parent or responsible party signature               Date



Consent for Treatment With Medication (All Patients Except One Time Evals Read and Sign)

You may be treated here with medication. Medications have potential side effects. Your doctor will discuss potential medication side effects or adverse reactions. Please report any possible side effects or adverse reactions you are having.


_____________________       ______________________________       _________

Patient Signature                       Parent or responsible party signature               Date

Consent for Evaluation Only and Not Treatment (Only for Private or Agency Evaluation)

By signing this I understand that I am not a patient of PASSNJ. I am only here for a one-time evaluation. I do not become a patient until I inform the doctor of such and treatment is initiated. I agree to abide by the other pertinent policies as noted.


______________________       ______________________________       _________

Patient Signature                       Parent or responsible party signature               Date


Medicare/Medicaid/Private Insurance (All Patients Read and Sign):

This office does not participate in the Medicare or Medicaid Systems. If you have either of these forms of insurance, age into or acquire either of these insurances while in treatment you need to be aware that we are non-participatory. You are therefore entering into a private contract with this office for treatment that will not be reimbursed if you submit your bill. These insurers will not reimburse you for any fees you paid for any of your visits here under any circumstance.


______________________       ______________________________       _________

Patient Signature                       Parent or responsible party signature               Date

HIPAA and Electronic Transmission of Data (All Patients Read and Sign):
This office is HIPAA compliant with regulations, privacy of information and confidentiality. We offer HIPAA materials for you to read regarding confidentiality. Please ask for a copy of the HIPAA regulations if you would like it and initial below.

____I would like a copy of HIPAA regulations

____I would not like a copy of HIPPAA regulations


______________________       ______________________________       _________

Patient Signature                       Parent or responsible party signature               Date

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