1. Purpose of Telemedicine
Telemedicine allows the provider to deliver psychiatric evaluation, medication management, and follow-up care through secure audio-video technology when clinically appropriate. Telemedicine may be used in place of in-person visits or to supplement
in-person care.
2. Technology and Security
Telemedicine services are provided through a HIPAA-compliant platform with a signed Business Associate Agreement (BAA). The platform uses industry-standard encryption to protect electronic protected health information (ePHI). Sessions are not recorded unless explicitly discussed and agreed upon in writing.
3. Patient Identity Verification
To ensure safety and compliance, the provider may verify your identity at the start of each session using your full name, date of birth, and any additional identifiers if needed.
4. Confidentiality and Privacy
Your privacy is protected under the HIPAA Privacy Rule and HIPAA Security Rule. You are responsible for choosing a private location for your session and may use headphones to increase confidentiality. Any chat messages, documents, or images exchanged during telemedicine sessions are treated as PHI and stored only when clinically necessary.
5. Risks of Telemedicine
Telemedicine involves potential risks, including but not limited to:
• Technology failures such as poor connection or dropped calls
• Rare breaches of privacy due to technical issues
• Limited ability to respond to emergencies compared to in-person care
If a session is disrupted, the provider will attempt to reconnect or contact you by phone.
6. Benefits of Telemedicine
• Increased access to psychiatric care
• Reduced travel time and scheduling flexibility
• Continuity of care during illness, travel, or weather disruptions
• Ability to include family members or caregivers when appropriate
7. Emergency and Crisis Protocol
Telemedicine is not appropriate for emergencies. If you experience a crisis, call 911 or go to the nearest emergency room. You must provide your current physical location at the start of each session so emergency services can be directed to you if needed.
8. Participation of Others
If another person participates in your session, they must also provide consent. You may decline the presence of any third party at any time.
9. Patient Rights
You have the right to:
• Withdraw consent for telemedicine at any time
• Request in-person appointments when available
• Ask questions about the telemedicine process
• Request confidential communication methods
10. Substance Use Information (If Applicable)
Information related to substance use disorder is protected under federal confidentiality rules and will not be shared without your additional written consent, except as permitted by law.
11. Financial Responsibility
Telemedicine services may be billed to insurance or paid out-of-pocket. You are responsible for understanding your coverage and any copays or fees.
12. Consent Statement
By signing below, you acknowledge and agree that:
• You understand the risks, benefits, and alternatives to telemedicine.
• You understand your privacy rights and responsibilities.
• You consent to receive psychiatric services via telemedicine.
• You understand you may revoke consent at any time.
