Telehealth Consent
Social Media, Provider and Client Relationship, & Telehealth Social Media
*Services refers to counseling, psychiatry, case management, psychological services, primary care
* Providers refers to counselors, social workers, psychiatric nurse practitioners, medical personnel, psychologists, or other direct service care staff.
Social media forums are not HIPAA compliant forms of confidential communication between a provider and patient. To protect your confidentiality, we will not “friend” you on Facebook, accept a “friend request,” Tweet, Instagram, LinkedIn, Pinterest, or any other social media means to participate in communication with you.
Patient and Provider Relationship
The patient and provider relationship is a professional relationship that is set up for your treatment and care. Providers are held to very high ethical standards of treatment and are prohibited from engaging in what is called “dual relationships” with patients. This means, providers are not allowed to provide services to persons they have a formed relationship with already that is personal and once services are in progress or ends a relationship that is personal or professional outside of the servicing realm is considered unethical.
For confidential purposes, if you see your counselor outside of the counseling room please note that counselors are not allowed to come up to you but you can come up to them in a community setting. This is for your protection. Therefore, the counselor is not ignoring you when we walk by without saying hello instead we are allowing you to choose whether you want to at that time to engage in a conversation.
Telehealth and Telemedicine
Telehealth or telemedicine are used interchangeable to mean the same thing. This is a type of service via electronic means such as a telephone or video. There are times when your provider may be traveling outside of Arizona and may offer telehealth services while out of town. This is permitted as long as the provider is licensed in the state you are residing in at the time of services. When you travel out of state you must make sure our provider is licensed in the state you travel to. Most of our providers are only licensed in Arizona. This means if you travel outside of Arizona we are not able to provide services to you until you return.
Things to consider when using telehealth:
Benefits: Include the opportunity to explore needs and continued treatment progress with a provider.
Risks: If you share there is an emergency or concern we are not physically available to help you so will need to inform local authorities such as 911 or police to help you if you are not able to provide a satisfactory response that ensures safety. If you hang up the phone or video and we cannot reach you after you tell us there is an emergency we will have to send police to your residence. We will provide the officers with your name, phone number, address, diagnosis, statements of safety concern and any other information that is pertinent to help you to be safe.
Alternative means of services: While absent, another provider can be scheduled with you if you choose.
Email: Your clinician assigned to you will send out an email to you provided by you with the link for the video online telehealth forum for counseling. Please follow the link. We also use a video format called Healow. You can download Healow on any smart devide or access with a company. If using another video format, our office uses HIPAA compliant Zoom and Google Meets platforms. To make follow up appointment call or email: 602-358-7073 or frontdesk@terishealthservices.org
In an emergency: You are to contact 911 or local police department, not your provider or the front desk. If you are at a facility or group home please go to your staff first. If you have a crisis please dial 988.
Confidentiality: When using telephone communication or video format please make sure you are in a private location. This will ensure your confidentiality. In terms of your provider, when we meet with you we will be in a private setting that is not around other people or in public.
Technology failure: If the phone or video goes dead or bad service results we will contact you again or at a later time, if when failure results and you have shared with us a crisis situation we will contact police for a wellness check or crisis.
Anticipated response time: If you contact the front office they will get back to you within 24 hours or by next business day. You can also text securely to 602-825-1513.
Time zones: When we are out of town I will ensure you are aware of time zone changes.
Body language and nonverbals: Please note that telehealth communication restricts the provider’s ability to recognize your nonverbal reactions and needs (we cannot see tearfulness, difficulty with controlling emotion, or physical ailments), therefore, we may ask about presentation throughout the session. This may also mean that we may ask directly about your feelings and behaviors. Most insurance health plans require telehealth be a video format to cover the expense. If you are using insurance you agree to use video and show your face.
License to practice: Most of our direct care staff (i.e., providers) are licensed in the state of Arizona or practicing in the state of Arizona. We hire independently licensed and associate level licensed professionals. We hire non licensed staff as well. All non-Independently licensed professionals are provided the opportunity for Clinical Supervision.
Email, Text, Phone Calls During Working Week – If you have questions or need to schedule or cancel please call the front office directly. You and your provider will set up follow up an appointment after each visit. If you need to cancel please do so within 24 hours of the appointment date as this helps the provider to schedule another person in that time spot. It also reduces the chance you will be required to pay a cancellation fee.
Email: You can email front desk team at frontdesk@terishealthservices.org. This is a fully secured email and staff will respond within 24 hours or next business day. You can also email leadership@terishealthservices.org if you having problems getting through.
Text: Texting is not a secure means of communication on normal smart devices. Providers will not text with you on your personal cell phone and their SMS text. We have a secure text you may use for questions that is the office text line at: 602-825-1513.
Client:
Understands that telemental health/medical services are completely voluntary and that you can withdraw this consent at any time.
Understands that none of the telemental/telemedicine health sessions will be recorded or photographed.Understands not to make or allow audio or video recordings of any portion of the sessions.
Understands that the laws that protect privacy and the confidentiality of client information also apply to telemental health/telemedicine, and that no information obtained in the use of telemental health/telemedicine that identifies you will be disclosed to other entities without your consent.
Understands that telemental health/telemedicine is performed over a secure communication system.
Understands that any internet based communication is not 100 % guaranteed to be secure.
Understands that the provider/therapist and Company (THS) will not be held responsible if any outside party gains access to your personal information by bypassing the security measures of the communication system.
Understands there are potential risks to this technology, including interruptions, unauthorized access, and technical difficulties.
Understands that you or your provider/therapist may discontinue the telemental/telemedicine sessions at any time if it is felt that the video technology is not adequate for the situation.
Understands that if there is an emergency during a telemental health/telemedicine session, then my therapist/provider may call emergency services and/ or my emergency contact.
Understands that this form is signed in addition to the Notice of Privacy Practices and Consent to Treatment and that all office policies and procedures apply to telemental health/telemedicine services.
Understands that if the video conferencing connection drops while you are in a session, my therapist/provider will contact me back. During the evaluation process at times your therapist/provider will complete an evaluation over the phone. All therapists/providers who call from Teri's Health Services are held to the same practice procedures as in office providers/therapists. All providers/therapists over telemental health/telemedicine services are mandated reporters by law. If your the client reports they might harm themselves or someone else or hang up the phone during session and you have stated risk of harm your therapists/providers is permitted by Arizona law to break confidentiality to get you help or someone else in foreseeable harms way. In addition, if you as the client/patient are in crisis and you hang up the phone and your therapist/provider is unable to contact again 911 or the nonemergency line will be contacted to respond for help.