Office Standards for Social Distancing and Hygiene

Choices Mental Health Counseling PLLC

Narrowsburg, NY 12764
Office Policy on Social Distancing and Covid19 Safety

INFORMED CONSENT CONCERNING PUBLIC HEALTH PRECAUTIONS IN COUNSELING SERVICES DURING A PANDEMIC
Choices Mental Health Counseling PLLC is committed to providing quality care to its clients in the form of counseling for mental health and substance use recovery. During a pandemic, the standard of care that we provide must include reasonable safety precautions to protect individuals and society from potential viral infections. At the present time, most appointments for individual and group therapy are conducted by online video conferencing (also known as Tele Mental Health or Telehealth), but there may be times to come to the office.

Precautions outlined here are intended to enhance personal and public safety during a pandemic health crisis. At the present time, the preferred method of meeting for most counseling sessions (individual and group) is by Telehealth.

Subject to appropriate social distancing and hygiene, when it is not against guidance received from civic and public health authorities, we may see physically healthy clients in-person in the office. One example of when an in-person visit might include collection of urine to help monitor abstinence from alcohol and other drugs in support of recovery-related treatment goals. At other times, consideration might be given to in-person individual counseling sessions in the office.

The term "social distancing and hygiene" as used here means remaining several feet apart from other people in the office at all times (including the counselor and any others), and wearing a face mask that covers the mouth and nose, washing hands regularly, not shaking hands, and appropriate use of hand sanitizer.

Whenever a client or other visitor to the office is found to have a temperature of 100 Fahrenheit or above, or exhibits or reports other potential symptoms of illness, they will not be seen at the office. Instead, they will be advised to call their medical provider for advice, and will be offered a remote appointment by Tele Mental Health counseling.

It has long been our practice, and it still is, to ask all clients to sign HIPAA-compliant consents to release of information allowing communication with other healthcare providers for coordination of care within the bounds of professional confidentiality.

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Date last tested for COVID19 (leave blank if never tested)

MonthDayYear
Date
Results of most recent COVID19 test:

Positive or presumed positiveNegativeOther or unknown
Have you been vaccinated for COVID19?*

YES (please provide date[s] of vaccination below).NOT YET, but I plan to do so as soon as it is available to me.NO, and I do not plan to do so.
Optional comments
Date(s) vaccinated (if applicable):
Name*

First NameLast Name
Email*
example@example.com
I agree to the precautions described above pertaining to in-person office visits, while also agreeing to keep all appointments with my counselor that are scheduled to be held online or provide 24 hours notice if I cannot do so.
Client's Signature*

Clear
Date Signed:*

MonthDayYear
Date
Rev. 1/2/2021
Should be Empty:

Choices Mental Health Counseling PLLC

Office Policy on Social Distancing and Covid19 Safety