Terms of service
Clinical Policies, Responsibilities, and Treatment Goals.
Shariful Syed MD PLLC
Tel.: 516.522.0410
Fax: 516.301.9111
Email: SAS@sharifulsyedmd.com
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Welcome to Dr. Syed’s practice!
In order to provide you the best and most appropriate care, Dr. Syed would like to share with you what you can
expect from him and your responsibilities as his patient.
Dr. Syed will always listen to you and think about the best course of management based on your needs,
resources, and wishes. All first encounter’s (initial assessments) are considered consultations pending individual
feedback and discussion of an agreed upon treatment plan that may result in entering the practice for continued
treatment and follow up.
Depending on the level of stability medication management patients are expected to be seen (at a minimum)
monthly, and after relative stability of symptoms, they may no longer require to see Dr. Syed as often. Many
patients can even have their psychiatric medications prescribed by their primary care physician (PCP), and Dr.
Syed is happy to help you with this transition. Dr. Syed is committed to helping you making progress in jointly
defined treatment goals as fast as possible. Still, it’s important to remember that each person responds
differently to interventions, and things (particularly these days) do not always go as planned. Be sure Dr. Syed
will do everything in their power to help you live a productive and meaningful life.
Ia. If prescribed medication(s): Patients must agree to take medications as prescribed. This includes not taking a
dosage higher than prescribed, not altering the dose without consulting with your provider first, medication non-
compliance, abruptly stopping medications or skipping doses. If medication non-compliance is demonstrated,
Dr. Syed reserves the right to end the patient-doctor relationship. If you are prescribed controlled substances,
you will need to come monthly until Dr. Syed, and you agree you can come every two or even three months.
New York State does not allow more than a 90 day supply to be prescribed. Prescription for controlled
substances will not be sent for more than seven (7) days if you miss your scheduled and needed appointment.
Disability matters: We are unable to make a determination about any pending disability cases. Your providers’
role is to assess and diagnose your mental health needs, therefore, we are only able to provide documentation
that speaks to the following: mental health diagnosis, presentation, symptoms, medication, history, response to
treatment, and treatment plan. If a lawyer requests additional information regarding your ability to perform
certain work duties, we will be unable to provide or complete this. Please consult a disability expert for further
assistance.
Ib. Pre-intake: Dr. Syed will need recent blood work results from you, which you can get from your PCP or present
to a nearest lab (i.e. quest diagnostics) and have lab tests drawn. This is important to make sure your symptoms
are not due to a medical condition, which many times can affect one’s mood, sleep, appetite, etc. If there are
factors that Dr. Syed appreciates as raising risk of a heart rhythm problem, an EKG may be required. This can
be easily done at your primary care physician’s office.
Ic. Emergent situations: In case you experience a psychiatric emergency, you will need to seek emergency care in
the hospital. Dr. Syed believes that emergencies need to be taken care of in the proper setting - an emergency
room. If you feel the need to talk, discuss, ask something to Dr. Syed before your scheduled appointment, feel
free to reach out to him. Calls/messages are generally returned/answered within 24-48 hours.
Scheduling/Payment: Invoices and scheduling will be conducted via use of online software/applications
(Docusign / Calendly / Gmail/ Invoice software) and less otherwise agreed upon, payments are due after (same
day) each encounter. Only cash, check, or zelle are accepted. Dr. Syed will provide you an invoice that you can
submit to your insurance upon request. Unfortunately, Dr. Syed is unable to schedule future appointments or
release your records if there’s any outstanding balance. Delay in doing so (2 weeks) may result in discharge
from his clinic. Further if you miss your appointment, do not respond to Dr. Syed’s contact attempts to create a
clinically necessary follow up visit and do not respond in a timely manner - that will also result in discharge
from his care.
It’s very important to foster a good doctor-patient relationship. If, for any reason, Dr. Syed believes he is not the
right doctor for you, he will discuss with you about transferring your care to another clinicians/clinic in the
community, who he believes will serve your treatment better. The above policies are designed in mind to foster
the most therapeutic/effective structure to patient care - which may seem unkind at times however it is done
with the patient (yourself) as the top priority. Appropriate termination will be done to the best of Dr. Syed’s
ability - (provision of list of local clinics referrals as well as urgent care/emergent care locations).
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Confidentiality
Your medical records may be accessible to other clinicians in the office. Your personal information will NOT
be released outside of MUC without your signed consent or a subpoena. Exceptions include suicide or homicide
issues or child/elder abuse or neglect. Children/Adolescents (individuals under the age of 17) have the right to
confidential exchanges with clinician’s unless there are issues that pose immediate danger.
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Release of Information
Adults: To maximize the efficacy of your treatment, if there are other providers from whom you are receiving
treatment pertinent to our work - this will serve to allow Dr. Syed to disclose the minimum necessary
information to facilitate the best clinical outcome.
Children/Adolescent: For matters relating to IEP or ongoing counseling or future counseling for your child at
school - it would be prudent to leverage the support that school affords to a child’s treatment. This is to hereby
allow Dr. Syed to disclose the minimum necessary information to support the best outcome for
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Professional Fees
You will be expected to pay the fee agreed upon by your provider for any clinical/professional services being
offered. Billable services include (but are not limited to): telephone consultations lasting longer than 10 minutes,
meetings, or sessions with family or other treatment providers, and written records or treatment summaries to
be sent elsewhere (subject to modification as needed and deemed appropriate by Dr. Syed). If you require your
psychiatrist participate in any legal proceedings, you will be responsible to cover the cost of any professional
time used. Fees vary per clinical circumstances and timeliness in which evaluation and treatment is sought -
Initial eval range from 475-600USD ; Follow up range from 250-300USD. In exceptional circumstances Dr.
Syed does offer sliding scale accommodation however this has to be explicitly agreed upon and documented.
A viable payment method must be kept on file at all times for automatic billing after clinical services have been rendered.
IVa. Payment for Services
This is a fee for service model that is cash based. Dr. Syed is willing to assist with out of network claims
however the burden is on the patient to provide and complete all documents. Invoices with all required information
for processing of out of network claims will be provided. Dr. Syed will not take responsibility for this being
done and is not obligated to do so. Due to inefficient burden in processing PA’s Dr. Syed will not do so;
however, every effort will be made to attain discount and/or insurance approving medication alternative if
clinical circumstances are permitting. Missed appointments or failure to cancel your appointment within 24
hours, will result in full responsibility of session fee.
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Medical Record Access
Dr. Syed will strive to do what he believes clinically optimal for your care - that also pertains to the medical
records which you will be granted access to. The nature of our work will feature very private/sensitive
information from both sides. To protect your information and the integrity of the clinical record Dr. Syed may
provide a written summary of treatment in lieu of specific medical record/therapy note documentation. Again,
this is based on a modern interpretation of the Hippocratic Oath, Amerian Medical Association Code of Ethics,
Federal Law, and New York State Common law. These actions are in line with the HIPAA Act of 1996 (45
CFR Parts 160 and 164) and the preempting state law of New York State - PHL § 18 (3)(d)(i)).
MINORS: If you are under 18 years of age, please be aware that the law may provide your parents the right to
examine your treatment records. For adolescents older than 12 years of age, I will do my utmost best to discuss
any information I deem clinically necessary (to help you best in my role as your doctor) to share with your
parents.
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Communication
As a supplement to your in-office appointments, I am inviting you to use email and text messages to
communicate with my practice. Set forth below are policies outlining when and how email and text
messages should be utilized to maintain your privacy and to enhance communication as well as a
place for you to acknowledge your consent to its use. Your decision to utilize this form of
communication is strictly voluntary, and your consent may be rescinded at any time. Emails and text
messages will be accessed by Dr. Syed ONLY. You may expect any required response within 24-
48 hours. If Dr. Syed is on vacation, your emails and or texts will not be answered until he returns
from vacation.
VIa. When may I use email and text messages to communicate with Dr. Syed?
-Prescription refill requests.
-Appointment requests.
-Other matters not requiring an immediate response.
VIb. When should I NOT use email and text messages to communicate with Dr. Syed?
Never to be used:
-In a true emergency, period.
-If you are experiencing any desire to harm yourself or others.
-If you are experiencing a severe medication reaction.
-If you need an immediate response
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VIc. What are the advantages of using email and/or text messages?
-Unlike trading voicemail messages, email and text message allows you to see exactly the
question the doctor is responding to and having a written record of that exchange for future
reference.
-Email and text messages allow for the rapid transmission of forms or other paperwork, such
as information regarding your medications/condition.
-Dr. Syed uses end-to-end encryption for email so you can have some assurance as to the
privacy of any and all correspondences with Dr. Syed
VIId. Risk associated with electronic communication
-Email and text messages may be seen by unintended viewers if addressed incorrectly.
-Email and text messages may be intercepted by hackers and redistributed.
-Someone is posing as you could access your information.
-Email can be used to spread computer viruses.
-There is a risk that emails may not be received by either party in a timely matter as it may
be caught by junk/spam filters.
-Emails are discoverable in litigation and may be used as evidence in court.
-Emails can be circulated and stored by unintended recipients.
-Statements made via email and text messages may be misunderstood thus creating
miscommunication and/or negatively affecting treatment.
-There may be an unanticipated time delay between messages being sent and received.
VIIe. What happens to my messages?
-Emails will be maintained as a permanent part of your medical record.
-As part of your permanent record, they will be released along with the rest of the record upon
your authorization or when the doctor is otherwise legally required to do so.
VIIf. What are my obligations?
-I must let Dr. Syed know immediately if my email address changes.
-If I do not receive a response from Dr. Syed in the time frame indicated above, I will contact
her by telephone if a response is needed.
-I will use email and text messages communication only for the purposes stated above.
-I will advise Dr. Syed in writing should I decide that I would prefer not to continue
communicating via email or text message.
-I understand that email and text messages may only be used to supplement my
appointments with Dr. Syed and not as a substitute for them.
-To avoid possible confusion, I will not use internet slang or short-hand when communicating
via email or text message.
VIIg. What steps has Dr. Syed taken to protect the privacy of my email and text message
communications?
-Utilizes end-to-end encryption email (not text yet).
-Set up a password-protected screen-saver on computer computer and cell phone.
-Does not access patient email from public Wi-Fi hotspots.
-Does not allow any one else usage of devices which access electronic communication or
records. .
-Will not transmit highly sensitive information via email or text message.
-Will not forward the patient's email to third parties without your express consent.
-Will verify email addresses before sending messages.
VIIh. What steps can I take to protect my privacy?
-Do not use your work computer to communicate with Dr. Syed as your employer has a right
to inspect emails sent through the company’s system.
-Do not use a shared email account to transmit messages.
-Log out of your email account if you will be away from your computer.
-Carefully check the address/telephone number before hitting “send” to ensure that you are
sending your message to the intended receiver.
-Avoid writing or reading emails and text messages on a mobile device in a public place.
-Avoid accessing email on a public Wi-Fi hotspot.
-Make certain that your email is signed with your first and last name and include your
telephone number and date of birth to avoid possible mix up with patients with the same or
similar names.