Introduction of Telebehavioral Health:
- As a client receiving behavioral services through telebehavioral health technologies, I understand: Telebehavioral health is the delivery of behavioral health services using interactive electronic technologies between a clinician and client(s) who are not in the same physical location.
- I understand that I must maintain visual and audio privacy during telehealth sessions including an appropriately private, quiet location wihout distractions from other people or devices. It is my responsibility to respect and protect the privacy of fellow group members if I participate in group telehealth sessions.
- Electronic systems used will incorporate network and software security protocols to protect the privacy and security of health information and imaging data, and will include measures to safeguard the data to ensure its integrity against intentional or unintentional corruption.
Benefits & Limitations:
- Telehealth may provide access to treatment that would not otherwise be available to me.
- I will need access to, and familiarity with, the appropriate technology in order to participate in the service provided.
Exchange of Information:
- The exchange of written information may be indirect, via screen, email or post.
- During my telebehavioral health consultation, details of my medical history and personal health information may be discussed with myself or other behavioral health care professionals through the use of interactive video, audio or other telecommunications technology.
Termination:
- I may decline any telebehavioral health services at any time without jeopardizing my access to future care, services, and benefits.
- Telehealth services may be discontinued by Connections due to changes in government regulations, insurance or policy. My clinician and I will regularly reassess the appropriateness of continuing to deliver services to me through the use of the technologies we have agreed upon today, and modify our plan
as needed.
Emergency Protocol / Location:
- Your healthcare provider will assume you are located at home during your
telehealth session. If this is not the case, please advise your provider at the beginning of the session. Your location is important in the event emergency services are required during your session and to submit accurate billing claims to your insurer.
The laws and professional standards that apply to in-person behavioral services also apply to telehealth services. This document does not replace other agreements, contracts, or documentation of informed consent.