Samantha Heather Russell, APRN, MSN

Monarch Mental Health

(913) 291-0076
www.monarchmentalhealthkc.com

Current Availability

updated 04-11-2023
Accepting new patients/clients

Location

4121 W. 83rd Street, Suite 254
Prairie Village, KS 66208
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Insurance Accepted

Blue Cross Blue Shield
Aetna
United Healthcare
Other

About Me
Consultation Request

Samantha takes a compassionate, holistic, evidence-based approach towards her treatment of children, adolescents, and adults. Her approach allows clients to feel heard and understood, helping them to achieve their goals. Samantha provides diagnostic evaluation, medication management, and supportive therapy services and treats a wide variety of conditions. She accepts patients age 5 years old and up.

Samantha is a Board Certified Psychiatric-Mental Health Nurse Practitioner. She earned her Masters degree from the University of Kansas School of Nursing after graduating Magna Cum Laude from Creighton University School of Nursing.

Treatment Focus

Anxiety/anxiety attacks
Attention Deficit Disorders (ADD/ADHD)
Autism
Behavioral difficulties
Bipolar Disorder
Depression
Eating Disorders
Mood Disorders

Obsessive Compulsive
Oppositional Defiance
Panic attacks
Phobias
Post-traumatic Stress
Self Esteem
Stress

Get started: request a consultation with Samantha Heather Russell, APRN, MSN

This form helps prospective patients/clients and clinicians connect more efficiently and explore whether the requested relationship will be a good fit. As clinician skill sets, availability, and financial policies vary, this form helps ensure you find the right clinician for your needs.

If you are or believe you are experiencing a medical or psychiatric emergency, including suicidal or homicidal thinking, side effects to medication, or any other urgent or time-sensitive matter in which you need an immediate response, do not use this service. Instead call 911 or go to your closest emergency room.

This request is not an emergency or urgent matter. I wish to proceed

Clinical Info

Please tell us about the person for whom treatment is being requested

Patient/client first name *

Patient/client last name *

Patient/client gender *

Date of birth *

My relationship to the patient/client *

My phone number *

How were you referred to me? *

What are the presenting concerns? Please be as detailed as possible. *

List any previous psychiatric diagnosis. *

List ALL current medications, including Psychiatric and for any other medical condition. *

List any Past Psychiatric medications and the response. *

Who was the previous Psychiatric Provider?
Please list the Prescriber and therapist if applicable. *

Are there previous psychiatric hospitalizations?
If so, when and for what reason? *

Is there a history of past suicide attempts?
And/or self harm behaviors? *

List any Psychiatric problems in the family,
including who and if treated/hospitalized.
Has anyone committed/attempted suicide? *

Who is the Primary Care Provider?
List any Medical conditions or past surgeries. *

Describe any issues with birth or development.
(Premature, trauma at birth, exposure to medications or illicit drugs during pregnancy, delayed milestones, etc)
If adopted, at what age? *

What is the highest level of education achieved?
Please note if any academic difficulties including 504 Plan or IEP. *

Describe current occupation/place of employment.
(For children, please list occupation for each parent/guardian.) *

Who else live in the home?
(For children, additionally note if parents/guardians are married/divorced/remarried, custody arrangement etc.) *

Gender assigned at birth?
Gender Identity?
Sexual Identity/Orientation?
Current relationship? *

List any substance used in the past or currently including: alcohol, tobacco, marijuana, or any other illicit drugs and frequency used. *

Please describe any significant stressors, including history of abuse (emotional/physical/sexual) or exposure to traumatic events or violence. *

List hobbies/Interests. *

List any spiritual/Religious affiliations. *

Describe any past or current legal problems. *

List any Allergic Reactions to medications. *

What is your preferred pharmacy? *

Payment Info

What will be the primary payment method? *

Blue Cross Blue Shield

Aetna

United Healthcare

Other

If your insurance plan is accepted by the clinician, what is the policy ID number? For private pay, enter 'n/a'. *

Do you acknowledge/accept that If we do not accept your insurance, you will be seen as a private/self pay patient and that you are responsible for payment in full at the time service is rendered?
(If requested, you may be provided a statement that you can submit directly to your insurance for potential reimbursement.) *