Patient Portal Authorization

MENTAL HEALTH SOLUTIONS, INC

PATIENT PORTAL AUTHORIZATION

Mental Health Solutions, Inc., d/b/a Nirvana Health (“Mental Health Solutions”), provides an intuitive, secure, web-based method for patients to access portions of their records through our secure, encrypted web site. This portal is designed to be compliant with all HIPAA regulations regarding your privacy. Access to your portal is available from any computer with internet access. When you log into the Patient Portal, you will be able to view portions of your medical record, including previous and upcoming appointments and insurance information. Since this information is your private medical record, we recommend that you only access your portal from a secure location.

Protecting Your Private Health Information and Risks

Only the patient or someone authorized by the patient/legal representative may access the information on the Patient Portal. Please protect your password and only share it with individuals that you wish to view your medical information. If you find that someone unauthorized has your password, you should promptly go to the website and change it. Mental Health Solutions understands the importance of privacy in regards to your health care and will continue to strive to make all information as confidential as possible and will never sell or give away any private information.

Conditions of Participation in the Patient Portal

Access to the secure web portal is an optional service, and we may suspend or terminate it at any time and for any reason. If we do suspend or terminate the service we will notify you as promptly as we reasonably can. If you lose or cannot remember your username and password, you may opt to have the system automatically reset your password by use of the website and receive the new password by e-mail. You agree to hold harmless Mental Health Solutions of any network/access infractions beyond their control.

Patient Acknowledgement and Agreement

By completing the online Patient Portal registration and clicking [“I agree”], checking a related box to signify my acceptance, or otherwise affirmatively accepting the terms and conditions outlined under this Agreement, I acknowledge that I have read and fully understand the Policies and Procedures regarding the Patient Portal, which are set forth in our Privacy Policy, https://www.meetnirvana.com/legal/privacy-policy and our Patient Terms and Conditions, https://www.meetnirvana.com/legal/patient-terms-and-conditions-of-use, and I understand the risks associated with online communications between my medical provider’s office and me, and consent to the conditions outlined herein. In addition, I agree to follow the instructions set forth herein, as well as any other instructions that my medical provider’s office may impose to communicate with patients via online communications. I understand and agree with the information that I have been provided.