Governing all telehealth and telepsychiatry services provided by Family1st Integrated Therapy & Wellness, LLC. This policy is binding upon all patients, prospective patients, and authorized representatives who access or seek to access telehealth services through this practice.
🆘 EMERGENCY NOTICE — READ FIRST: Telehealth is NOT an emergency service. If you are experiencing a psychiatric emergency, suicidal crisis, active self-harm, psychosis, or any life-threatening situation, do NOT use this platform. Call 911 immediately, go to your nearest emergency room, or call/text 988 (Suicide & Crisis Lifeline, 24/7). Text HOME to 741741 (Crisis Text Line). Telehealth providers cannot dispatch emergency services to your location.
Practice Name: Family1st Integrated Therapy & Wellness, LLC
Provider: Kristin McKnight, MSN, APRN, PMHNP-BC
Practice Address: Las Vegas, Nevada
Phone: 775.245.8200
Email: kmcknight@family1stintegratedtherapy.com
Website: www.family1st-integratedtherapy.com
This Telehealth Services Policy ("Policy") is issued pursuant to and governed by:
As used in this Policy, the following terms have the meaning specified:
Subject to clinical appropriateness and geographic eligibility, the following services may be delivered via telehealth:
The following services cannot be delivered via telehealth and require in-person assessment:
Clinical Discretion: The Provider reserves the right at all times to determine, in their sole professional judgment, that a particular patient's condition, acuity level, or clinical presentation requires in-person evaluation rather than telehealth. Such a determination does not constitute abandonment of the patient and will be accompanied by appropriate referral information.
Telehealth services through this practice are available exclusively to patients who are physically located in one of the following states at the time of each telehealth encounter. Licensure is verified as active at the time this Policy was issued and is subject to change:
At the commencement of each telehealth encounter, the Provider or designee will verbally verify and document the patient's physical location. The patient must state their physical location at the start of every appointment. This verification is a legal requirement, not a formality. The practice will document the patient's confirmed location in the medical record.
Patients physically located in states not listed in Section 4.1 may not receive telehealth services from this practice. Accessing services while located in an unlicensed state, regardless of the patient's state of residence, constitutes a violation of this Policy and may constitute unauthorized practice of medicine. If a patient is discovered to be located in an unlicensed state during an encounter, the session will be terminated and appropriate referral resources will be provided.
Patients who temporarily travel to an unlicensed state must notify the practice in advance of any scheduled appointment. The practice will work to reschedule or, where possible, provide a referral. Patients who permanently relocate to an unlicensed state will be provided with transition-of-care resources and a 30-day notice before services are discontinued, except where continued prescribing would violate applicable law.
Patients acknowledge that telehealth regulations vary significantly by state and that additional state-specific requirements — including but not limited to informed consent, prescribing restrictions, audio-only limitations, and mandatory in-person exam requirements — may apply based on the patient's physical location. The practice will comply with the most restrictive applicable law.
To be eligible for telehealth services through this practice, a patient must:
During every telehealth session, the patient is required to:
The following conduct may result in immediate session termination, suspension of services, or permanent discharge:
Written informed consent for telehealth services is required prior to any clinical encounter. No telehealth services will be initiated without documented consent. Consent may be obtained electronically through the ChARM Health patient portal and is legally valid under the Electronic Signatures in Global and National Commerce (E-SIGN) Act (15 U.S.C. § 7001 et seq.) and applicable state e-signature laws.
By providing informed consent, the patient acknowledges and agrees that:
Several licensed states impose specific telehealth consent requirements beyond the general federal standard. The practice complies with state-specific requirements including but not limited to:
Patients must have access to the following minimum technology requirements for synchronous telehealth visits:
All telehealth encounters are conducted exclusively through ChARM Health, a HIPAA-compliant Electronic Health Record and telehealth platform. ChARM Health has executed a Business Associate Agreement (BAA) with this practice as required by 45 CFR § 164.308(b). The practice does not conduct clinical telehealth encounters through FaceTime, Zoom (consumer version), WhatsApp, standard telephone calls (for video-required encounters), or any non-HIPAA-compliant platform.
Audio-only telephone encounters may be permitted in limited circumstances where:
Audio-only encounters may be billed at a different rate and are subject to additional clinical documentation requirements. Medicare audio-only telehealth for behavioral health is currently permitted through December 31, 2027 under the Consolidated Appropriations Act.
In the event of a technical failure during a session:
This practice is a HIPAA-covered entity. All patient information collected in connection with telehealth services constitutes Protected Health Information (PHI) and is subject to the HIPAA Privacy Rule (45 CFR Part 164, Subpart E) and Security Rule (45 CFR Part 164, Subpart C). For a full description of the practice's privacy practices, see our Notice of Privacy Practices.
Psychotherapy notes are afforded heightened protection under HIPAA (45 CFR § 164.508(a)(2)) and may not be disclosed without specific written authorization, except in the narrowly defined circumstances permitted by law. This protection is distinct from and more restrictive than general medical record protections.
Records pertaining to substance use disorder (SUD) diagnosis, prognosis, treatment, or referral are governed by 42 CFR Part 2, which imposes protections more stringent than HIPAA. SUD records may not be disclosed or used in any civil, criminal, administrative, or legislative proceedings without patient written consent, except as specifically authorized by 42 CFR Part 2. Patients receiving SUD-related services will execute a separate 42 CFR Part 2-compliant consent form.
This practice implements the following administrative, physical, and technical safeguards for telehealth-related PHI:
The Provider holds full prescriptive authority as a Psychiatric-Mental Health Nurse Practitioner-Board Certified (PMHNP-BC) in all 14 licensed states. Prescribing decisions are made at the sole clinical judgment of the Provider and are subject to applicable state prescribing laws and regulations, which vary by state.
Prescribing of controlled substances (DEA Schedules II–V) via telehealth is governed by the Ryan Haight Online Pharmacy Consumer Protection Act (21 U.S.C. § 831(h)) and DEA regulations at 21 CFR Part 1300 et seq. The DEA's Special Registration for Telemedicine (where implemented) and any applicable DEA exemptions or emergency authorities will be applied as required. The practice will not prescribe Schedule II–V controlled substances via telehealth except in strict compliance with applicable federal and state law at the time of prescribing.
⚠️ Important Notice Regarding Telehealth Prescribing Regulations: Federal telehealth prescribing rules for controlled substances are subject to ongoing regulatory change. DEA telemedicine prescribing exemptions implemented during the COVID-19 public health emergency are subject to scheduled expiration and revision. This practice will comply with current applicable law at all times, which may limit the ability to initiate or continue certain controlled substance prescriptions via telehealth. Patients will be notified in advance of any changes that affect their treatment.
Prescribing of buprenorphine (including buprenorphine/naloxone) and other Schedule III–V controlled substances for opioid use disorder via telehealth is subject to DEA registration requirements and the Mainstreaming Addiction Treatment (MAT) Act of 2023, which eliminated the DATA 2000 waiver requirement. The Provider will comply with all applicable DEA registration requirements, state OUD treatment regulations, and applicable SAMHSA guidelines. Patients must acknowledge that continued buprenorphine prescribing via telehealth is contingent on regulatory status and may require in-person evaluation.
Prior to prescribing any controlled substance, the Provider will query the Prescription Drug Monitoring Program (PDMP) for the patient's state of residence, and where required by law, the PDMP of the patient's state of physical location. Patients must consent to PDMP query as a condition of controlled substance prescribing. Refusal to consent to PDMP query will result in inability to prescribe controlled substances through this practice.
The Provider may require urine drug screening (UDS) as a condition of continued controlled substance prescribing. Patients must cooperate with UDS requirements at a laboratory facility in their state. Refusal or failure to complete required UDS may result in discontinuation of controlled substance prescriptions. Results of UDS are PHI and are protected under applicable privacy law. SUD-related UDS results may also be subject to 42 CFR Part 2 protections.
Prescriptions are transmitted electronically via DEA-registered electronic prescribing (ePrescribing) or, for Schedule II controlled substances where required, via paper prescription or DEA-compliant electronic prescribing for controlled substances (EPCS). Patients are responsible for selecting a pharmacy and maintaining an active pharmacy on file with the practice.
This practice is a certified Spravato REMS Healthcare Settings provider. Spravato (esketamine) is a Schedule V controlled substance approved by the FDA for Treatment-Resistant Depression (TRD) and Major Depressive Disorder with acute suicidal ideation or behavior (MDSI). The Spravato REMS program imposes mandatory safety requirements that cannot be modified or waived by patient or provider agreement.
Spravato must be self-administered by the patient under the direct supervision of a healthcare provider in a certified healthcare setting. Spravato cannot be administered at home, remotely, or without direct observation. The REMS program prohibits dispensing Spravato for at-home use under any circumstances. Patients who receive Spravato must:
While administration sessions must be in-person, telehealth may be used for:
The Provider commits to delivering telehealth services consistent with the standard of care applicable to Psychiatric-Mental Health Nurse Practitioners practicing in the relevant jurisdiction. The telehealth modality does not diminish or alter the Provider's professional and ethical obligations under applicable nursing practice acts, state regulations, and professional standards established by the American Association of Nurse Practitioners (AANP) and the American Psychiatric Nurses Association (APNA).
Patients acknowledge that telehealth psychiatric care has inherent limitations including, but not limited to:
The Provider may, at any time and in their sole clinical discretion, determine that a patient requires in-person evaluation. This may occur due to clinical complexity, diagnostic uncertainty, safety concerns, or changes in the patient's condition. Upon such determination, the Provider will communicate the requirement to the patient and provide referral resources. Refusal by the patient to complete a required in-person evaluation may result in the Provider's inability to safely continue telehealth prescribing or management.
🚨 CRITICAL — READ AND RETAIN: This practice CANNOT provide emergency psychiatric services via telehealth. In ANY psychiatric emergency, call 911 or go to the nearest emergency room immediately. Do not wait for a telehealth appointment. Do not send messages through the patient portal for emergencies — the portal is not monitored 24/7.
If a patient presents with suicidal ideation, homicidal ideation, active self-harm, or other psychiatric emergency during a telehealth session, the Provider will:
Patients with a history of suicidal ideation, self-harm, or psychiatric hospitalization must complete a Safety Plan with the Provider prior to initiation of telehealth services. The Safety Plan will be maintained in the patient's ChARM Health record and reviewed at each visit as clinically indicated.
Many of the practice's licensed states have enacted telehealth parity laws requiring that insurers cover telehealth services at the same rate as equivalent in-person services. The practice will bill telehealth encounters using appropriate procedure codes with applicable telehealth modifiers (modifier 95, GT, or 02 depending on payer and service type) in compliance with CMS billing requirements and state parity laws.
Medicare telehealth billing is governed by CMS requirements under 42 CFR § 410.78. The practice bills Medicare telehealth encounters in compliance with current Medicare telehealth coverage requirements, including applicable originating site, distant site, and service type requirements. Patients are advised that Medicare telehealth coverage rules are subject to change by CMS or Congress.
In compliance with the No Surprises Act (effective January 1, 2022), the practice will provide a Good Faith Estimate (GFE) of expected charges prior to scheduled telehealth services for uninsured or self-pay patients. Insured patients have the right to receive an Explanation of Benefits from their insurer following each encounter.
Insurance eligibility for telehealth services will be verified prior to each encounter where feasible. Coverage is not guaranteed and patients are responsible for their applicable deductibles, copayments, coinsurance, and any non-covered services. The practice will inform patients of self-pay rates prior to service initiation.
All telehealth encounters will be documented in the patient's ChARM Health electronic health record. Documentation will include, at minimum: date and time of encounter, modality (video/audio), patient's confirmed physical location, clinical assessment, diagnosis, treatment plan, prescriptions, and follow-up plan.
Medical records for telehealth patients will be retained in accordance with applicable state law. Nevada law requires retention of medical records for a minimum of 7 years from the date of the last entry (NRS 629.051). Records for minors will be retained until the patient reaches age 21 or for 7 years from the date of the last entry, whichever is longer. Records pertaining to SUD treatment are subject to 42 CFR Part 2 retention requirements.
Telehealth sessions are not routinely recorded by the practice. Session recording by the Provider, if any, will be disclosed to the patient in advance and governed by applicable law. Unauthorized recording of telehealth sessions by patients is prohibited and constitutes a violation of this Policy and potentially applicable wiretapping or eavesdropping laws.
Patients receiving telehealth services retain all rights afforded to patients receiving in-person care, including:
Patients who have concerns, complaints, or grievances regarding telehealth services may:
The Provider reserves the right to discontinue telehealth services with a patient for any of the following reasons, provided that the patient is not abandoned and transition-of-care resources are provided:
Upon termination of the provider-patient relationship, except in cases of immediate safety risk, the practice will provide: 30 days' advance written notice where feasible, a summary of care and active medications, referral resources appropriate to the patient's clinical needs, and access to medical records upon patient request.
This practice provides telehealth psychiatric services to adolescents aged 13 through 17 with appropriate parental or legal guardian consent, and to adults aged 18 and older. Services are not available to children under age 13.
For patients aged 13–17, a parent or legal guardian must provide written informed consent for telehealth services prior to the initiation of care. The consenting parent/guardian must be available and reachable during the minor's telehealth sessions. Exceptions to parental consent may apply where state law grants minors the right to consent to mental health or substance use treatment independently (e.g., California Health & Safety Code § 124260, Nevada NRS 129.030).
Confidentiality for minor patients will be governed by applicable state law, which varies by jurisdiction. Where state law permits minors to consent to certain treatments independently, the minor's confidentiality regarding those treatments will be protected. The practice will disclose its policies regarding minor confidentiality during the intake process.
Prescribing of controlled substances to minor patients is subject to heightened clinical scrutiny, state-specific prescribing restrictions for minors, and mandatory parental notification requirements where applicable. The Provider will comply with the most protective standard applicable to each patient's jurisdiction.
This Policy is governed by the laws of the State of Nevada, the state of the practice's principal place of business. To the extent that the laws of the patient's state of physical location impose additional or more protective requirements, those requirements shall govern for services delivered to patients in that state.
Where applicable, the Provider participates in the Nurse Licensure Compact (NLC) and maintains licensure in compliance with all applicable Compact provisions. Licensure status is verified and maintained current in all 14 licensed states.
Where a conflict exists between the laws of Nevada and the laws of the patient's state of physical location, the practice will apply the standard most protective of patient safety and rights, and will seek guidance from applicable licensing board or legal counsel as necessary.
Federal law, including HIPAA, the Ryan Haight Act, DEA regulations, and applicable CMS requirements, shall govern to the extent of any conflict with state law.
This Policy may be amended at any time to reflect changes in applicable law, regulatory requirements, clinical standards, or practice operations. Material changes will be communicated to active patients via the ChARM Health patient portal or by direct written notice at least 14 days before the effective date of the change, except where immediate amendment is required by law or patient safety. Continued use of telehealth services following notice of an amendment constitutes acceptance of the revised Policy. The most current version of this Policy will be maintained on the practice website at www.family1st-integratedtherapy.com/telehealth-policy.html.
Provider: Kristin McKnight, MSN, APRN, PMHNP-BC
Practice: Family1st Integrated Therapy & Wellness, LLC
Address: Las Vegas, Nevada
Phone: 775.245.8200
Email: kmcknight@family1stintegratedtherapy.com
Patient Portal: ChARM Health — access through Book Appointment
By executing the Telehealth Informed Consent and Patient Intake Agreement, the patient acknowledges receipt of this Telehealth Services Policy, confirms they have read and understand its terms, and agrees to be bound by all provisions herein as a condition of receiving telehealth services from Family1st Integrated Therapy & Wellness, LLC.