Karen Ginsburg, LCSW
255 S 17th St Suite 1602 Philadelphia PA 19003
kginsburg.lcsw@gmail.com
917-349-1671
NY LCSW: 077234-1 PA LCSW: CW016616
EIN: 26-1468208. NPI: 1962563486
In order to provide you with the most comprehensive treatment, it is helpful for me to know if you currently take, or have taken medication to assist your mental health, as well as to have the opportunity to consult with your prescribing physician if needed.
Please list any current medications you are taking that are related to your mental health and the date you started. (It is fine if you can't remember the exact date. A rough estimate is fine.)
Please list a history of medications you have taken in the past, benefits, side effects and your reason for discontinuing.
If you are open to my coordinating your care with your prescribing physician, please indicate below and I will provide you with an informed consent form.
Yes, I would like coordination with my prescribing physician.
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No, I do not want coordination with my prescribing physician at this time.
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