Consent for Telehealth Treatment

I understand that all existing laws regarding my access to medical information and copies of my medical records apply to telehealth consultation. Additionally, dissemination of any client-identifiable images or information from telehealth interactions to other entities shall not occur without my consent, unless authorized under existing confidentiality laws.

I understand that reasonable and appropriate efforts have been made to eliminate any confidentiality risks associated with telehealth consultations. All existing confidentiality protections under federal and Oklahoma State law apply to information disclosed during telehealth consultations.

Risks and Consequences

The telehealth consultation will be similar to a routine office visit, except interactive video technology will allow you to communicate with a clincian at a distance. At first you may find it difficult or uncomfortable to communicate using video images. The use of video technology to deliver mental health and educational services is a new technology and may not be equivalent to direct contact.

Rights

You may withhold or withdraw consent to telehealth consultations at any time without affecting your right of future care or treatment, or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled. You have the option to consult with the clinician in person (if it is safe to do so) if you travel to his or her location.