TELEPSYCHIATRY CONSENT

 

What is Telepsychiatry?

The delivery of psychiatric services using interactive audio and visual electronic systems between a physician and a patient, whom are located in different physical locations. The interactive electronic systems used in telepsychiatry, incorporate network and software security protocols to protect the confidentiality of patient information, audio and visual data. Telepsychiatry allows greater access to, and compliance with treatment, avoiding the need for transportation to appointments. Participating in psychiatric appointments from the comfort of one’s home is considered by many to be a benefit.

Identity and Location Verification

  • All patients must have a drivers license with photo on file for confirmation of identity.

  • All patients must be residents of Virginia and physically located in Virginia for all video sessions.

Telepsychiatry Limitations and Risks:

  • Although rare, occasionally video services are not available due to an unplanned service malfunction or equipment failure. In this circumstance, sessions will occur via telephone if the patient is in agreement otherwise, the appointment will be rescheduled.

  • If a patient is deemed to have clinical needs that make telepsychiatry a poor clinical fit, referrals to alternative treatment providers will be provided.

  • A telepsychiatry session will not be exactly the same, and may not be as complete as a face-to- face service.

  • There could be some technical problems (video quality, internet connection) that may affect the telepsychiatry session and affect the decision making capability of the provider.

  • The provider may not be able to provide medical treatment using interactive electronic equipment, nor provide for or arrange for emergency care that you may require.

  • A lack of access to all the information that might be available in a face to face visit, but not in a telepsychiatry session, may result in errors in judgment.

  • Delays in medical evaluation and treatment may occur due to deficiencies or failures of the equipment.

  • Gray MD Psychiatry LLC, utilizes software that meets the recommended standards to protect the privacy and security of the telepsychiatry sessions. However, the service cannot guarantee total protection against hacking or tapping into the telepsychiatry session by outsiders. This risk is small, but it does exist.

 

Patient’s Rights

  • I understand that HIPAA laws that protect the privacy and confidentiality of medical information also applies to telepsychiatry. Gray MD Psychiatry utilizes a HIPAA compliant version of the online video platform, Zoom.

  • I understand that I have the right to withdraw or withhold my consent to the use of telepsychiatry at any time during the course of my care. Due to covid-19, my treatment sessions may not be able to be converted to in person sessions, alternative providers in the area will be provided.

  • I understand that the laws to protect the privacy and confidentiality of medical information also apply to telepsychiatry.

  • I understand that I will not be allowed to record telepsychiatry sessions without written consent from Gray MD Psychiatry. I also understand that Gray MD Psychiatry will not record sessions without my consent.

  • I understand that Gray MD Psychiatry will always take the utmost care to ensure other persons cannot hear or see any part of the treatment session. We encourage all patients to ensure they have the highest level of privacy to discuss all relevant topics and feel comfortable during all sessions.

  • I understand that it is my responsibility to ensure the proper functioning of my electronic equipment before my session begins. If there are interruptions or delays  due to equipment or service malfunctioning, we will do everything in our power to make up for lost time, less than 10 minutes. Any malfunction greater than 10 minutes, may require rescheduling.

  • I understand that I can only engage in telepsychiatry sessions as a resident of Virginia and when I am physically present in the state of Virginia. I will have to confirm my location at the beginning of each session.

  • I understand that all practice policies and procedures and other consents signed for this practice apply to telepsychiatry sessions, including but not limited to cancellation policies, fees etc.