New Patient
Information
Due to the high
volume of applications, Mercy Family Center is now on a waiting
list. We are extremely sorry for any inconvenience that this
may cause and are doing our best to schedule as many clients as
possible. If this is an emergency or you feel as though you
are a danger to yourself or others;
please call 911 or the
COPEline
(504) 269-2673
for immediate assistance.
Mercy Family Center is currently unable
to meet the demand for psychological or educational assessments.
The identification of conditions that prevent children from
achieving in school has been an integral part of Mercy Family
Center’s service to the New Orleans community for the past 19 years.
However, we are currently backlogged with requests for assessments
and highly recommend that parents seek other providers in the
community to provide this service. A list of local licensed
psychologists who provide psychological and educational assessments
can be found by
clicking here.
Note:
All applicants must fill out
the Initial Intake Form before acceptance to Mercy Family
Center for service. Please read the following information below
and click ACCEPT to apply.
“Please remember
that Mercy Family Center is primarily a child and adolescent behavioral
health practice. Therefore, we reserve the right to screen clients
for their appropriateness to our practice. Thank you.”
Introductory Consent
to the Use and Disclosure of Health Information
for Evaluating Potential New Patient
I
understand that as part of my (or my child’s) New Patient
Intake Evaluation, Mercy Family Center originates and maintains
paper and/or electronic records describing my (or my child’s)
health history, symptoms, examination and test results, diagnoses
and treatment. I understand that this information serves as:
• A basis for evaluating potential care
and treatment,
• A means of communication among the Mercy Family Center clinical staff
who may be asked to contribute to my (or my child’s) care,
• A means by which a third-party payer can verify that services being considered
are covered under my (or my child’s) health plan.
I understand that the information I provide
will be used only by Mercy Family Center staff and disclosed
only to a third party payor to verify my insurance coverage
during this intake evaluation process. I understand that
if I (or my child) is accepted as a patient by Mercy Family
Center, I will be asked to sign a New Patient Consent Form
and will be provided with a Notice of Information Practices
that details a complete description of protected health information
uses and disclosures by Mercy Family Center. I understand
that if I (or my child) am not accepted as a patient, all
protected health information I have provided to Mercy Family
Center will be destroyed. No record of my intake evaluation
will be retained by Mercy Family Center.
I understand that I have a right to decline
this consent. I also understand that by declining this consent,
Mercy Family Center may refuse to treat me as permitted by
Section 164.506 of the Code of Federal Regulations.
I fully understand and accept (per location)
/ decline the terms of this consent.
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Be sure to check the appropriate
acceptance buttons for Children or Adults below:
For CHILDREN (Only)
Accept the appropriate location:
110
Veterans Blvd, Suite 425
Metairie, LA 70005
Phone: 504.838.8283 |
1445
West Causeway Approach
Mandeville, LA 70471
Phone: 985 727-7993 |
3221 Behrman
Place, Suite 105
New
Orleans, LA 70114
Phone: 504.376.2590 |
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For ADULTS (Only)
Accept the appropriate location:
110
Veterans Blvd, Suite 425
Metairie, LA 70005
Phone: 504.838.8283 |
1445
West Causeway Approach
Mandeville, LA 70471
Phone: 985 727-7993 |
3221 Behrman
Place, Suite 105
New
Orleans, LA 70114
Phone: 504.376.2590 |
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Hurricane
Assessment Instrument
Below
Hurricane
Assessment Instrument
The
following survey will allow our clinicians to better
serve your child and family by identifying possible
Hurricane-related stressors. Please take a moment
to complete as much of the survey as is relevant to
your child’s personal experience.
Thank
you.
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