Telehealth Consent Regarding Confidentiality

Cognitive Clarity

Effective Date: January 1, 2025

 

Introduction

Telehealth is a delivery of health services using interactive technologies (e.g., phone or video sessions) between a practitioner and a client who are not in the same physical location. All practice policies remain the same, including that you agree to be on time for your session, and you follow the practice’s cancellation policy if you are unable to attend your appointment.

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Confidentiality

We understand that a telehealth session has potential benefits including easier access to care, the convenience of meeting from a location and time of your choosing, and the ability to limit one’s physical contact with others. However, there are potential risks to this technology, including interruptions, unauthorized access, and technical difficulties.​

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Confidentiality Measures

• We use a confidential, HIPAA-compliant video platform that safeguards data and provides a secure platform. However, there is always the potential risk to client confidentiality when the internet is involved, and this risk is heightened in a group format.

• To maintain confidentiality, you will not share your telehealth appointment link with anyone unauthorized to attend the appointment.

• You will not record or photograph any part of the group or the group members, or allow anyone into your room while the group is in session.

• You may learn the full names of group members due to their name being listed on the video. You agree not to seek out any information about group members (e.g., using a search engine or social media), nor contact them outside of the group if this is against the specific group agreements. If you choose not to show your full name, you will ask the group leader how to change your display name, if you do not know how to do it.

• You need to have access to the appropriate technology to participate in the service provided. This includes being on a secure internet connection, rather than public or free Wi-Fi. For video sessions, being in a room where there is good lighting, keeping the video steady by either placing your computer on a hard surface or leaning your phone against something sturdy, and keeping your camera on throughout the entirety of the session.

• You need to be in a location free of disruptions, where you are alone and can speak freely, and where others will not see the screen or hear the conversations of the group. This may include using headphones if necessary.​

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Additional Information

• If you are under the age of 18, you need the written permission of your parent or legal guardian to participate in telehealth.

• If you are using insurance benefits, you will confirm with your insurance company that telehealth group therapy sessions will be reimbursed.

• You have access to your provider so you can ask any questions you have about potential risks, benefits, and any practical alternatives to telehealth.

• You can decline telehealth services at any time without jeopardizing access to future care. You can inform your provider that you would prefer to wait until the next in-person appointment. If in person is not available, you will be referred to another provider. 

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Contact Information

If you have any questions about this consent or if you need more information, please contact our office.