The purpose of this Addendum to PsychCare's Services Agreement is to outline our policies regarding in-person services and to obtain your written agreement to adhere to those policies and your consent to receive in-person services.
Availability: The availability of in-person services will vary with time and situation and from patient to patient, depending on many factors. Such factors include current laws and regulations; guidance from healthcare authorities; and the health and exposure risks of specific staff, patients, and their close contacts. Thus, after starting in-person services, those services may suddenly become unavailable, necessitating a switch to telehealth or a transfer to other services instead.
Benefits: In-person services, when permitted by authorities and conducted safely, may at times be preferable to telehealth services, such as for clinical reasons, or for patients with limited access to telehealth technology or telehealth insurance coverage.
Risks: The risks of in-person services will vary with time and situation. Those risks include the risk of exposure to COVID-19, illness, death, and spreading the infection to others. A potential privacy risk is that if PsychCare learns that anyone (including staff, patients, or others) with COVID-19 has had contact with others through our office, we may be required to report those contacts to health authorities for purposes of contact tracing (only the minimum necessary information would be released, not mental health-related details
Client responsibilities: You agree that the following safeguards must be followed by you and by anyoneaccompanying you to an in-person appointment or to the office if you or the accompanying person are NOT fully vaccinated:
Inform us immediately and do not attend any in-person appointments if any of the following are true:
High-risk job/activities - if your activities or close contacts (job, spouse's job, ride-share partner, etc) expose you to suspected or confirmed cases of COVID-19,
Underlying risk - if you or anyone with whom you have close contact (household member, close co-worker, someone you ride in a car with, etc) is not fully vaccinated and is at elevated risk for severe illness from COVID-19 due to age, underlying health condition, or other known risk factor,
Recent exposure - if you had exposure in the past 2 weeks to anyone with a confirmed or suspected case of COVID-19
Symptoms - if you have any COVID-19 or other/similar symptoms, including fever, cough, or shortness of breath.
Your other responsiblities:
Precautions - Take precautions to minimize potential exposure to COVID-19 between appointments.
Mask - Enter wearing an appropriate mask or cloth face covering and do not remove until after leaving.
Health screening - Cooperate with any requested PsychCare health screening prior to the appointment (which may include an electronic or paper questionnaire, temperature check, etc
Hand hygiene - Wash hands or use hand sanitizer immediately upon entering.
Face hygiene - Try to avoid touching your face or mask while present. If you do, wash or sanitize hands immediately.
No contact - Avoid all physical contact with others while present.
Physical distancing - Stay at least six feet from others wherever physically possible.
Touchless exchanges - Use touchless payment methods (a credit card on file) and handle forms electronically if possible.
Cooperate - Cooperate with any other policies or staff instructions that may be necessary as conditions change.
Our Responsibilities: PsychCare staff who are NOT fully vaccinated are also expected to follow the above safeguards (except that we may wait in our individual offices rather than outside PsychCare policie and safeguards for in-person appointments may change in response to changing conditions. PsychCare understands that some of the above safeguards may be inconvenient and even, for some, controversial. Please be assured that we take seriously our responsibility to set policies based not on politics or personal opinions, but on guidance from pertinent federal, state, local, and professional authorities, including but not limited to health department authorities, our clinicians' licensure boards, our professional associations' ethics experts, our malpractice insurers, and our attorneys.
Your signature below indicates that you have read this entire agreement, that you consent to in-person services, that you accept the risks of in-person services, that you agree to cooperate with the above safeguards and other relevant PsychCare policies, and that you take responsibility for making sure anyone who accompanies you to the appointment does the same. If you are a parent or guardian consenting for a minor child, your signature also attests that the child's other parent or legal guardian does not object to these services.