Psychiatric Nursing & Clinical Social Work Services
Telepsychiatry provides psychiatric services using interactive video conferencing tools, similar to Skype (but more secure and HIPAA compliant), in which the provider and the patient are not at the same location. Telepsychiatry will allow you to participate in psychiatric care without the need to visit the office or travel long distance.
Potential risks include, but may not be limited to: information transmitted may not be sufficient (poor resolution of video); delays in medical evaluation and treatment due to deficiencies or failures of the equipment; security protocols can fail, causing a breach of privacy; and a lack of access to all the information available in a face to face visit may result in errors in medical judgment. Alternatives to telepsychiatry include traditional face to face sessions.
1. I understand that the laws that protect the privacy and confidentiality of medical information also apply to telepsychiatry;
2. I understand that the software being used (VSee) is known to incorporate network and software security protocols to protect the confidentiality of information and audio/visual data. These protocols include measures to safeguard the data and to aid in protecting against intentional or unintentional corruption. You can review the security features of VSee at https://vsee.com/hipaa
3. I have the right to withdraw my consent to the use of telepsychiatry during the course of my care at any time.
4. I understand that Denise Wittlin-Horvath, LCSW-R, NPP has the right to withhold or withdraw consent for the use of telepsychiatry during the course of my care at any time;
5. I understand that all rules and regulations which apply to the practice of medicine in the State of New York also apply to telepsychiatry.
1. I will not record any telepsychiatry sessions without the prior written consent of Denise Wittlin Horvath, LCSW-R, NPP and I understand that Denise Wittlin-Horvath, LCSW-R, NPP will not record telepsychiatry sessions without my consent;
2. I will inform Denise Wittlin-Horvath, LCSW-R, NPP if any other person can hear or see any part of our session before the session begins. Denise Wittlin-Horvath, LCSW-R, NPP will ensure that no other person can hear or see any part of the session before the session begins. This is so that your privacy can be protected.
3. I understand that I MUST be a resident of New York State to be eligible for telepsychiatry services from Denise Wittlin-Horvath, LCSW-R, NPP.
Your signature below indicates that you have read and understand the information provided above regarding telepsychiatry and that you authorize Denise Wittlin-Horvath, LCSW-R, NPP to use telepsychiatry in the course of diagnosis and treatment.