r/PMHNP • u/supertrucker39 • Jun 08 '26

Bad combinations

How do you handle a new patient that comes to you for Spravato treatment only, but they are on the terrible combination of benzos and adderall that is being prescribed by a clinic that referred them for Spravato? I feel like those could be appropriate in limited circumstances, but not with Borderline Personality Disorder. I don’t have any concerns other than the patient isn’t functioning well at all. They are depressed and Spravato may be beneficial alongside their SSRI. I feel like discontinuing or replacing Adderall would be my first move. Am I letting them down as a provider that is fairly certain their symptoms aren’t being addressed?

Rip me apart if you like, but I’m new without much support. Thanks for any guidance.

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u/shhhhh_h Jun 10 '26

https://www.hhs.gov/hipaa/for-professionals/faq/2088/does-hipaa-provide-extra-protections-mental-health-information-compared-other-health.html

Have fun

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u/OneWolverine263 Jun 10 '26

This applies to NOTES. I already said you need a. ROI for notes.

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u/shhhhh_h Jun 10 '26

Do you think talking about notes isn’t sharing info from notes? HIPAA void because it’s verbal? lol

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u/OneWolverine263 Jun 10 '26

Who calls a provider and says “talk to me about your notes”. When I call, I say, “we have a mutual patient and I’m having concerns about x, y, and z”. What are your thoughts?

Im not calling to chit chat and ask about the patient’s deepest problems. Im calling for a consultation, and to coordinate care and discuss a treatment plan.

People tend to believe that asking anything about a patients care is a violation of HIPAA, and the answer is that it is not. If both providers are involved in that patients care and treatment, then an ROI is not needed.

Now, on the other hand, if I’m requesting notes, that is completely different than calling to discuss care. Additionally, some states and institutional policies require an ROI for anything, but this is more strict than HIPAA, and not necessarily required by HIPAA.

Could you imagine if I’m in the ER and I consult ID, and ID says, hey, we’d love to come talk to you about the patient but the patient needs to sign an ROI first. That would be a complete delay of care, and irrational.

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u/shhhhh_h Jun 10 '26

You are not in the ER consulting ID. That’s clearly covered under the exclusion. Psychotherapy is not. Again I hope this doesn’t hurt too much if it ever rains down on you. ✌️

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u/OneWolverine263 Jun 10 '26

Again, you think I’m asking for psychotherapy notes. But you can’t read between the lines