Consent for Telehealth Treatment

What is Telehealth?

Telehealth is using video and audio to provide healthcare services when the provider and the client are not in the same location. Telehealth uses sound and video or sound only.

I understand that telehealth is the use of electronic information and communication technologies by a healthcare provider to deliver services to an individual when the individual is located at a different site than the provider. I hereby consent to Vantage Point Behavioral Health providing health care services to me via telehealth.

Telehealth Terms and Conditions

• Professional Conduct: I understand that telehealth must be conducted appropriately and ethically. Staff and clients are expected to be in a location with privacy and not engage in other activities unrelated to the services being provided at the time. Excessive background noise, moving vehicles, lack of privacy, or other issues impacting services are grounds for ending the service.
• Potential Risks: I understand that while there are many benefits of telehealth in reducing barriers to treatment, there are potential risks, which include, but are not limited to:
  • It may not be appropriate for the treatment of serious psychiatric illness or symptoms.
  • It may not be appropriate for more complex situations.
  • Telehealth can sometimes prevent the exchange of important information such as facial expressions, vocal signals, or body language that may be less evident through telehealth.
  • Sessions may have to be interrupted or discontinued if technology issues interfere with the ability for the service to be provided in a clinically appropriate and ethical manner.
  • Telehealth interferes with clinicians' ability to utilize interventions, such as those using specific materials or tools.
  • Telehealth may limit the ability of a practitioner to identify a symptom that is not apparent through telehealth.
• Regulatory Compliance: I understand that Vantage Point Behavioral Health can only provide telehealth services as permitted by national, state, and individual insurance company regulations. Telehealth services may not be available as insurance coverage or regulations change. Some insurances do not permit telehealth services.
• Recording and Storage: I understand that telehealth communications are not recorded or stored.
• Privacy and Confidentiality: I understand that the laws that protect privacy and the confidentiality of medical information also apply to telehealth. As always, your insurance carrier will have access to your medical records for quality review/audit. Other limitations of confidentiality, as reviewed in Vantage Point Behavioral Health's consent to treatment, continue to apply.
• Financial Responsibility: I understand that I will be responsible for any copayments or coinsurances that apply to my telehealth visit.
• Right to Withdraw Consent: I understand that I have the right to withhold or withdraw my consent to the use of telehealth during my care at any time without affecting my right to future care or treatment. I understand that during a state of emergency, Vantage Point Behavioral Health may only be providing telehealth services, and refusal to consent may lead to an inability of Vantage Point Behavioral Health to provide treatment.
• Revocation of Consent: I may revoke my consent orally or in writing at any time by contacting Vantage Point Behavioral Health at (443) 836-5550. If this consent is in force (has not been revoked), Vantage Point Behavioral Health may provide health care services to me via telehealth without the need for me to sign another consent form.