![]() I understand that I can print this consent form at will.I understand I am responsible for making those appointments immediately to prevent gaps in my care.Upon such discharge, I understand that I will be given a list of alternate providers in my area from which I may choose for the continuation of my psychiatric care.I understand that having psychotropic medications prescribed by a non- Lasting Serenity Telepsychiatry, INC provider, except in a psychiatric urgency or emergency that warrants it, may result in immediate discharge and end my patient-provider relationships with Lasting Serenity Telepsychiatry, INC.Our Facilities Lasting Serenity Telepsychiatry, Inc has been registered with the National Provider Identifier database since Octoand its NPI number is 1285396366 (certified on ). I acknowledge my right to refuse any medication dose or withdrawal my consent for medications at any time. Free Business profile for LASTING SERENITY TELEPSYCHIATRY INC at 11123 Wortham Crest Cir, Manassas, VA, 20109-5689, US. Lasting Serenity Telepsychiatry, Inc is a psychiatric/mental health nurse practitioner practice located in Manassas, VA.Publication An Appointment Active Consenting for Telehealth TX the Offices Forbearing Portal Access. Email Address email protected Calls Us Today 57 Stay Connected. If I am a woman and have a possibility of pregnancy, I understand that I must tell my provider immediately to assess the risks and benefits of taking my prescribed medications. Lasting Serenity Telepsychiatry, INC is committed to provision quality mental heath care services in Virginia. I understand psychotropic medications may have risks that include side effects, age-related risks, rare and potentially life-threatening side effects, as well as fetal risk for pregnant women.Such verbal consent confirms that information about my medications was explained to my satisfaction and will be binding as noted in my health record. ![]() ![]() No lift but a very friendly and helpful staff. I understand that my prescriber of record will also ask me to provide voluntary verbal consent for any new medications, medication changes, and/ or the discontinuation of medications before they are ordered. Located so close to the citycenter - Ramblas, Port, Drassanes- not in an unsafe area.I understand that information about my medications will be provided in oral, and electronic form by my provider before any medication is prescribed.I am entitled to receiving information about the medications I am prescribed.I also confirm that I understand and voluntarily agree to the following: The current location address for Lasting Serenity Telepsychiatry Inc is 8665 Sudley Rd 228,, Manassas, Virginia and the contact number is 57 and fax number is. By electronically signing this form, I verify that I voluntarily consent to receiving prescriptions from my provider for psychiatric medications as a part of my treatment with Lasting Serenity Telepsychiatry, INC. The NPI Number for Lasting Serenity Telepsychiatry Inc is 1285396366.
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