Policies and Notifications
Telehealth Services Consent Form
Purpose
The purpose of this Telehealth Services Consent Form is to explain to patients and/or their parents/guardians about the benefits and risks of using telehealth services, inform them about their rights and confidentiality, and collect permissions from patients or their parents/guardians in order to receive telehealth services.
Telehealth Services
Telehealth is an online delivery of healthcare services which does not require patients and doctors to be in the same physical location (i.e. doctor's office). Through videoconference technology, telehealth treatment is provided by healthcare practitioners, specialists, and professionals. Interactive appointments are held via teleconference software that includes video and audio communication. This mode of communication and exchange is made through a secure channel that is private between the doctor and the patient.
CAFP uses an online telehealth platform called VidHealth to allow patients to have continuity of care given the current pandemic and COVID19 risks. VidHealth offers a secure, encrypted and HIPAA compliant telehealth platform and does not record any communications between participants whether audio or video. To see a more detailed description of security protocols visit
VidHealth.
Your participation in telehealth services is voluntary and you may withdraw your consent from participating in telehealth services at any time and seek other health care delivery services other than telehealth.
Benefits
- Patients can access healthcare services in remote sites thanks to telehealth technology
- Adds additional flexibility for scheduling appointments
- Open access for patients
- Secure and private
- Convenient
Risks
Although electronic means for psychotherapy appointments is increasingly common, there are potential risks to using an online platform:
- The audio/visual quality during appointments may vary due to internet speed
- Though every effort is made to ensure confidentiality, the limitations and risks in teleconferencing include public discovery, possibility of hackers, household noise or interruptions and other potential risks outside of the therapists’ control.
- Even with best practices using Telehealth, any information transmitted via the internet may not be 100% secure.
Confidentiality
Laws governing confidentiality to health information, including, but not limited to Health Insurance Portability and Accountability Act (HIPAA) applies to telehealth.
Medical and personal information of patients is kept private and protected by the state and governmental laws. Telehealth sessions are not recorded or stored in any capacity.
Patient Rights
- Patients have the right to have their questions or concerns addressed regarding the use of telehealth services, treatment process, and appointments before, during, or after the treatment.
- Patients can withdraw and withhold this consent at any time and they can end the treatment any time they would like to. Any action of patients will not affect the future treatment of or accessibility to counseling services.
Payment
Patients agree that they are responsible for paying any additional cost or payment that their insurance providers do not cover. Check with your insurance carrier to confirm that your benefit covers telemental health services.
Consent
To sign consent for telehealth services, please
contact me.