I consent to engage in telemedicine with my CCBH provider. I understand that telemedicine is the delivery of healthcare services using interactive audio and videoconferencing equipment where the provider and patient are in different locations.
Confidentiality and rights
I understand that all existing laws, rules and regulations associated with the practice of medicine in the State of California continue to apply to telemedicine. I understand that both the patient and the provider may withhold/withdraw their consent for the use of telemedicine at any time. This will not affect my other care or treatment. I agree not to record the telemedicine sessions without prior written consent from the provider and CCBH. I understand that my CCBH provider will not record the telemedicine sessions without my prior written consent. The CCBH provider will conduct the sessions in a private area and will notify the patient if anyone else is present. I agree to inform the provider if any other person is in the room or can hear or see any aspect of the session at any time. I understand that I must be residing in California and be physically present in California during the appointment to receive telemedicine services from CCBH.