Following is a statement of your rights, under the Privacy Rule, in reference to your PHI. (Protected Health Information) Please feel free to discuss any questions with our staff.

You have the right to receive, and we are required to provide you with, a copy of this Notice of Privacy Practices –

We are required to follow the terms of this notice. We reserve the right to change the terms of our notice, at any time. Upon your request, we will provide you with a revised Notice of Privacy Practices if you call our office and request that a revised copy be sent to you in the mail or ask for one at the time of your next appointment. The Notice will also be posted within the walls of the practice, as well as, on our website

You have the right to authorize other use and disclosure –

This means you have the right to authorize any use or disclosure of PHI that is not specified within this notice. For example, we would need your written authorization to use or disclose your PHI for marketing purposes, for most uses or disclosures of psychotherapy notes, or if we intended to sell your PHI. You may revoke an authorization, at any time, in writing, except to the extent that your healthcare provider, or our practice has taken an action in reliance on the use or disclosure indicated in the authorization.

You have the right to request an alternative means of confidential communication –

This means you have the right to ask us to contact you about medical matters using an alternative method (i.e., email, telephone), and to a destination (i.e., cell phone number, alternative address, etc.) designated by you. You must inform us in writing, using a form provided by our practice, how you wish to be contacted if other than the address/phone number that we have on file. We will follow all reasonable requests.

You have the right to inspect and copy your PHI –

This means you may inspect, and obtain a copy of your complete health record. If your health record is maintained electronically, you will also have the right to request a copy in electronic format. We have the right to charge a reasonable fee for paper or electronic copies as established by professional, state, or federal guidelines.

You have the right to request a restriction of your PHI –

This means you may ask us, in writing, not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. If we agree to the requested restriction, we will abide by it, except in emergency circumstances when the information is needed for your treatment. In certain cases, we may deny your request for a restriction. You will have the right to request, in writing, that we restrict communication to your health plan regarding a specific treatment or service that you, or someone on your behalf, has paid for in full, out-of-pocket. We are not permitted to deny this specific type of requested restriction.

You may have the right to request an amendment to your protected health information –

This means you may request an amendment of your PHI for as long as we maintain this information. In certain cases, we may deny your request.

You have the right to request a disclosure of accountability –

This means that you may request a listing of disclosures that we have made, of your PHI, to entities or persons outside of our office.

You have the right to receive a privacy breach notice –

You have the right to receive written notification if the practice discovers a breach of your unsecured PHI, and determines through a risk assessment that notification is required. If you have questions regarding your privacy rights, please feel free to contact our Privacy Manager. Contact information is provided on the following page under Privacy Complaints.

How We May Use or Disclose Protected Health Information

Following are examples of uses and disclosures of your protected health information that we are permitted to make. These examples are not meant to be exhaustive, but to describe possible types of uses and disclosures.

Treatment –

We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party that is involved in your care and treatment. For example, we would disclose your PHI, as necessary, to a pharmacy that would fill your prescriptions. We will also disclose PHI to other Healthcare Providers who may be involved in your care and treatment.

Special Notices –

We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment. We may contact you by phone or other means to provide results from exams or tests and to provide information that describes or recommends treatment alternatives regarding your care. Also, we may contact you to provide information about health-related benefits and services offered by our office, for fund-raising activities, or with respect to a group health plan, to disclose information to the health plan sponsor. You will have the right to opt out of such special notices, and each such notice will include instructions for opting out.

Payment –

Your PHI will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services we recommend for you such as, making a determination of eligibility or coverage for insurance benefits.

Healthcare Operations –

We may use or disclose, as needed, your PHI in order to support the business activities of our practice. This includes, but is not limited to business planning and development, quality assessment and improvement, medical review, legal services, auditing functions and patient safety activities.

Health Information Organization –

The practice may elect to use a health information organization, or other such organization to facilitate the electronic exchange of information for the purposes of treatment, payment, or healthcare operations.

To Others Involved in Your Healthcare –

Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person, that you identify, your PHI that directly relates to that person’s involvement in your healthcare. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care, of your general condition or death. If you are not present or able to agree or object to the use or disclosure of the PHI, then your healthcare provider may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is necessary will be disclosed. We may also disclose to the Dragonfly Integrated Care Group—for medical/behavioral collaboration as deemed appropriate.

Social Media –

We enjoy sharing news from our practice to you and the world at large. With your permission, we may use your photo, or your family member’s, photo on our website, Facebook page, Electronic Bulletin Board, or other media outlets. If you send us a photo then we will assume that you have implied consent. Our office also offers scholarships and that information may be posted on any or all of the above listed media venues.

Other Permitted and Required Uses and Disclosures –

We are also permitted to use or disclose your PHI without your written authorization for the following purposes: as required by law; for public health activities; health oversight activities; in cases of abuse or neglect; to comply with Food and Drug Administration requirements; research purposes; legal proceedings; law enforcement purposes; coroners; funeral directors; organ donation; criminal activity; military activity; national security; worker’s compensation; when an inmate in a correctional facility; and if requested by the Department of Health and Human Services in order to investigate or determine our compliance with the requirements of the Privacy Rule.

Privacy Complaints

You have the right to complain to us, or directly to the Secretary of the Department of Health and Human Services if you believe your privacy rights have been violated by us.

You may file a complaint with us by notifying the Privacy Manager at:

Atkinson Family Practice

17 Research Drive

Amherst, MA 01102

Effective Date: August 5, 2016

What if I don’t pay my co-pay at the time of visit?

  • Co-pays are expected to be paid at the time of check-in. If co-pay is not collected on date of service, there is an extra $10 fee.

What is the cancellation policy?

  • We currently ask for TWO hours for all cancellations and reschedules.
  • If your appointment was for an annual physical, there is a $50 fee, and if the appointment was a follow-up appointment, there is a $25 fee.
  • Michele LaRock and Dr. Wendy Chabot do require a different policy; 48 hours’ notice for cancellations and reschedules. Their late fee is $50.

What happens if I don’t show up for an appointment, or I’m late?

  • If you do not show for your appointment (or you are more than 15 minutes late to your appointment) you will be charged $25 for a regular visit and $50.00 for a physical and asked to reschedule your appointment.
  • If you know you are going to be late, please call to let us know; we will do everything we can to try to accommodate you.
Where/When can I reach AFP by phone? What are your hours?

  • Phone: 413-549-8400
  • Monday-Wednesdays our phones are on from 7:30 am-7:00 pm, and 7:30 am-5:00pm on Thursdays and Fridays
  • Our phones are off for lunch from 12:30pm- 1:30pm, but if you leave a message the front desk will call you as soon as they get back.

    What if I need to reach a provider after-hours?

    • After hours you have two options—
      • push 1 and you can leave a non-urgent message to be heard on the next business day.
      • Push 2 and you will be directed to the answering service who will page the doctor on call
    •  Please allow an hour for the provider to get back to you.
    • If it is a life-threatening emergency, don’t call us, call 911 or go to the ER. We will always approve an ER visit so you do not need to get permission from a doctor first.
    • We share on-call hours with South Deerfield Family Practice, so you may talk with one of their providers on nights or weekends. If you are waiting for a return call please keep your phone on so we can reach you!
    • *If for any reason you cannot reach us after hours (if phones or electricity are down for instance) you may also call the Cooley Dickinson hospital operator at 413-582-2000

      Can I contact AFP by e-mail?

      •  Each provider and the front desk have their own email addresses which they respond to personally. You can find them through our web site.
      • Please do not send emergency messages on email, as we do not necessarily check them every day.
      • Please do NOT e-mail about protected personal health information; communicate with your provider via the patient portal.
      • Please DO include your full name and Date of Birth when e-mailing
      • Email Guidelines:
        • Include your fill name and Date of Birth
        • Only discuss one patient on each individual email and no more than two problems on each note (it is okay to send multiple emails at the same time and it is actually easier for us to respond and file them if you keep different problems separate)
        • Always put the reason in the subject line.
        • Your email and patient portal messages will be entered into your computerized medical record.
      • If your problem is complex we may ask you to schedule an appointment.

        No one has responded to my e-mail! What do I do?!

        • Sometimes email messages get lost or stuck in the spam filter—if you haven’t heard back in two business days it is not impolite to follow up with a call or a repeat email. Email does not replace required follow up appointments as recommended by your provider.

          Are there privacy laws for e-mailing?

          •  Email is not a secure method for communicating your private health information. For your safety and privacy, all communications about protected personal health information must be sent to your provider through our secure patient portal. Please do not use email to communicate about medical information—the patient portal is your best tool to protect your privacy and communicate directly with your provider.

            What can I send over fax? What is the fax number?

            • 413-549-8409
            • Fax is a good way to send requests or short notes to us, such as lists of blood pressure results or blood sugar readings.
            • This is not a good way to have an interaction with your provider—please book an appointment for that.
              What is the lab upstairs?

              • We have Baystate Reference Lab located on the second floor of the Atkinson Building, and there are elevators to access it as well as stairs. You can get your bloodwork done here right after your appointment!

              What are the lab’s hours?

              • Monday-Friday 7am-3:30pm
              • They are closed for lunch daily from 12:30pm-1:30pm, just like the rest of the Atkinson Building.

              How can I see my most recent lab results?

              • The best way to look at your most recent lab results is to check your patient portal. Once we have received and reviewed your results, they will be posted to the portal. Please allow 24-48 hours for our providers to review your results once we have received them.
              How do I request a prescription refill?

              • We prefer prescription refill requests to come through your patient portal messaging system. However, if you are not able to send us a message via the portal, a quick call to the office is fine. Please allow 24 hours for all prescription refills to be processed and sent.
              • We prefer prescription refill requests to come through your patient portal messaging system. However, if you are not able to send us a message via the portal, a quick call to the office is fine. Please allow 24 hours for all prescription refills to be processed and sent.

              Do all prescription refill requests get filled in the same day?

              • In most instances we do try to do them same day; but we cannot guarantee it. Most medication refills do not constitute an emergency.
              • Please do not call on weekends/after hours for refills unless it is to leave a voice message for us to retrieve on Monday.

              Why can’t AFP fill my prescriptions on the weekends?

              • We want to make sure that our providers have time with their own families, so we ask that weekend/night calls are for urgent matters only.

              Can I talk with a provider and get a prescription over the phone?

              • We try not to practice “phone-medicine” here. Most of the time—with rare exceptions—if you or your family members are sick we will prefer to see you in the office. Prescribing drugs over the phone simply isn’t safe or good medicine.

              How can I transfer my records to another practice?

              • In order for your records to be transferred to another primary care office, you will need to fill out a medical release form. You can either fill one out with our office, or you may fill one out with the new practice you will be going to and they will send it to us. You may find our medical release form under the “Forms” sub-section of the resources section.

              Will there be forms to fill out at my next appointment? Can I fill them out before coming in?

              • An annual privacy form (HIPAA form) is required to be filled out once a year, as well as a financial responsibility form. You may find those forms located under the “Forms” sub-section of the Resources section.
              • If you have a change of insurance at any time, you will be required to fill out a new financial responsibility form.
              • We will also need your insurance card at each visit, so please remember to bring this to your appointment.

              What is a healthcare proxy?

              • The Health Care Proxy is a legal document that allows you to name someone you know and trust to make healthcare decisions for you if, for any reason and at any time, you become unable to make these decisions.
              How do I get onto the portal?

              • Follow the link on the website that will bring you to the portal. It will ask for your Username and Password. Please note that the username you were given by the office will remain the same, and the information is case sensitive. Should you need to reset your information, you may reset this online, or call the office who will gladly assist you.

              How can I see my most recent lab results?

              • The best way to look at your most recent lab results is to check your patient portal. Once we have received and reviewed your results, they will be posted to the portal. Please allow 24-48 hours for our providers to review your results once we have received them.

              Oh no! I locked myself out of my Portal. What do I do?

              • Give us a call at 413-549-8400 and we will reset it for you. Please bear in mind it may take up to half an hour for your portal to reset itself and let you back in after this occurs.

              If I leave the practice can I still access my portal?

              • Unfortunately, no. But if you give the front desk a call they can temporarily re-activate your account so you can access it for a brief period.



              Does AFP see patients over the weekend?

              • Our office does not have weekend hours, however we do always have a provider on-call both after hours during the week, as well as over the weekend. If needed, just call our office at 413-549-8400 and you will be prompted to talk to the service who will assist you.
              Where are you located?

              • Our office is at 17 Research Drive in Amherst, Massachusetts.

              Which bus do I take there?

              • You can take the Old Belchertown bus (the 30) to the last stop. Get off, and walk down Research Drive until you reach our building!

              Do you have bike racks?

              • Absolutely!
              Narcotic Medications?

              • Our office has a strict policy about prescribing narcotic medications.
              • We do not prescribe narcotics for chronic, non-cancer pain.
              • Feel free to talk to your provider about any of our policies.

              Medical Marijuana?

              • After consideration and discussion with all of our medical providers, we have made the decision not to become certified medical marijuana prescribers at this time. Many reasons factored into this decision. There is still limited evidence-based medicine to support marijuana’s use for most medical conditions. We don’t feel comfortable deciding the cutoff on who would qualify based on the nebulous wording in the statute and the lack of medical protocols for its use. Most of the major medical associations (AMA, ACP etc) do not take a position for or against medicinal marijuana, but all ask for further study before substantiating prescribing the substance. We want to continue to provide you with excellent care without taking on the administrative burden of medical marijuana prescribing. Currently, the certification for individual physicians in Massachusetts is very cumbersome and only available to MDs and DOs. Finally, it was noted that it is likely that marijuana will be legalized in Massachusetts in the coming years, removing the necessity for us to pursue this avenue. We will revisit this decision annually as needed. To our knowledge, there are and will be physicians providing this certification and we are not opposed to our patients seeking such care. We will continue to be the Medical Home for their other health concerns should they so desire it.
              Do you have x-ray capabilities at your office? If not, where do you send to?

              • Unfortunately our office does not have access to on-site x-rays, however we can send an order to the most convenient location for you. Most patients use the Cooley Dickinson location on University Dr. in Amherst.
              At Atkinson Family Practice, all of our providers are highly qualified, and have many, many years of experience behind them before they ever even meet with you. We have primary care providers, nurse practitioners, and physician’s assistants, and quite often get asked the difference between the three.


              A PCP is a doctor qualified to practice family medicine, and is usually a practitioner that knows the medical history of and consistently treats an entire family. Instead of focusing on a highly specified area of medicine, family PCP’s such as Doctor Kate focus on the overall health and emphasize the importance of preventative care. Seeing your doctor every year shouldn’t be a habit you grow out of after adolescence! Regular check ups are just as important for adults, too.

              Don’t wait until you’re sick to find a PCP. PCP’s see their patients regularly and keep an eye symptoms a patient might not notice at first, such as high blood pressure or hormonal imbalances. Allowing problems like these to go unnoticed for a long time can cause serious chronic health issues later down the line. At AFP, we require our patients to come in once a year for an annual physical, just to make sure none of these problems arise and, if they do, the best steps to treat them as early on as possible.


              PAs practice right alongside NPs and PCPs, and can prescribe medication in all 50 states, Washington D.C., and the majority of US territories. They are qualified to take your medical history, conduct annual physicals, diagnose and treat illnesses, order and interpret tests/lab results, work with patients to develop the best treatment plans, assist in surgery, and do hospital/home/nurse visits.

              In terms of education, PAs are generally in school for 3 academic years, and their course load satisfies the prerequisites to most medical schools. Additionally, most programs also require students to have at least 3 years of experience in the healthcare field. After their academia is complete, they are required to complete over 2,000 hours of clinical rotations in family medicine, internal medicine, obstetrics and gynecology, pediatrics, general surgery, emergency medicine, and psychiatry.


              NPs are on the rise as healthcare providers of choice for Americans, and combine their clinical experience in diagnosing/treating healthcare conditions while emphasizing the importance of disease prevention and health management. To become an NP, they must undergo the rigorous process of national certification, periodic peer review, clinical outcome evaluations, and live by a code of ethical practices. They must complete a master’s or doctoral degree program, and have extensive clinical training. Finally, NPs must lead and participate in professional and lay health care forums.


              Medical Records Release

              To Print This Form:
              Click the image below, and a PDF will open. Print it, fill it out, and drop it by the Front Desk or mail it to 17 Research Drive, Amherst MA 01002! You may also fax it to (413) 549-8409.
              The medical release form authorizes us to legally send your medical records to another provider, or obtain your records from your previous provider. For example, if you’re moving and want us to send your records to your new primary care provider, fill this form out and we can send all your records electronically.
              OBTAIN means we will contact another provider and request they send us your records. For example, if you’re new to the practice and want us to get your records from your old practice, fill out your previous primary care provider’s information here.

              DISCLOSE means we will send your records to another practice. For example, if you are moving and need us to send your records to a new practice, or are seeing a specialized doctor and they need to see your medical history, fill out the information of where you want the records to be sent.

              Yes, there is a fee based on the volume of your records if you wish to disclose them to yourself.
              If you don’t remember when your period of care with AFP began, no worries! We can figure that out based on your chart.
              Unless you check ENTIRE PERIOD OF CARE or specify a specific date, our custom is to send the most recent two years.
              These areas include highly sensitive and protected information related to testing, diagnosis, and/or treatment. We just want to double check you absolutely DO want these records sent before we send them, so we ask you check these sections off. Your privacy is our utmost concern!
              We request a 30 day notice to send all medical records.

              HIPPA (Fill Out Yearly)

              To Print This Form:
              Click the image below, and a PDF will open. Print it, fill it out, and drop it by the Front Desk or mail it to 17 Research Drive, Amherst MA 01002! You may also fax it to (413) 549-8409.

              Adult Registration Packet

              To Print This Form:
              Click the image below, and a PDF will open. Print it, fill it out, and drop it by the Front Desk or mail it to 17 Research Drive, Amherst MA 01002! You may also fax it to (413) 549-8409.

              TMS Forms

              Please fill out either of the forms below to see if you are qualified for treatment