The purpose of this Telehealth Services Policy and Consent Form is to explain to patients and their parents/guardians about the benefits and risks of telehealth services, inform them about their rights and confidentiality, and collect permissions from patients or their parents/guardians in order to participate into telehealth services.
Telehealth (aka: Telemedicine) involves the use of audio, video or other electronic communications to interact with you, consult with your healthcare provider and/or review your medical information for the purpose of assessment, testing, diagnosis, consultation, treatment, therapy, follow-up and/or education, and may include, but not limited to: patient medical records, medical images, and live two-way audio and video. Telehealth provides an electronic delivery of healthcare services which does not require for patients and the clinicians to be in the same physical location (i.e. doctor's office). Through the video call technology, telehealth practice/treatment is provided by healthcare practitioners, psychiatrists, nurse practitioners, licensed clinical social workers, other specialists and professionals. Interactive appointments are held via teleconference/video call platform that includes audio and video support communications.
Improved access to medical care by enabling a patient to remain in his/her home or at a remote site while the clinician is at his/her office or remote site.
More efficient medical evaluation and management
Obtaining expertise of a distant specialist
As with any electronic technology, there are potential risks associated with the use of telehealth. These risks include, but may not be limited to:
In rare cases, information transmitted may not be sufficient (e.g. poor resolution of images/video image) to allow for appropriate medical/clinical decision making by the clinician;
Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment, mobile devices, computers and internet connection;
In very rare instances, security protocols could fail, causing a breach of privacy of personal medical information;
In rare cases, a lack of access to complete medical records may result in adverse drug interactions or allergic reaction or other judgment error.
All existing confidentiality protections under federal and state law apply to information used or disclosed during your telehealth session. However, there are both mandatory and permissive exceptions to confidentiality including, but not limited to: reporting child, elder, and dependent adult abuse; expressed threats of violence towards an ascertainable victim; and where the patient makes his/her mental or emotional state an issue in a legal proceeding. Your insurance carrier will have access to telehealth medical records along with your other medical records by your clinician for quality review/audits.
Patients can withdraw or withhold this consent at any time. Any action will not affect the future treatment of patients. Patients can ask any question regarding telehealth services, treatment process, and appointments before, during, or after the treatment.