Agreement for Telehealth Services

The Digital Age continues to facilitate new ways to assist people to meet their mental health needs. I am happy to move in step with technological advancements to provide telehealth services. As part of my commitment to your well- being and safety, a few guidelines should be discussed. Please read this carefully.

Variously dubbed telemedicine, teletherapy, distance therapy, e-therapy, internet therapy, or online therapy, “telehealth” is defined as the use of electronic transmission to provide interactive real-time mental health services remotely, including consultation, assessment, diagnosis, treatment planning, counseling, psychotherapy, coaching, guidance, education, and transfer of medical information with an experienced psychiatrist/psychotherapist. This can include both video and audio forms of communication, via the internet or telephone. Telehealth services do not include texting or e-mail.

Telehealth is governed by all the same ethics and laws that cover in-office, in-person, face-to-face psychiatry/psychotherapy. So, all other policies and consents in the psychiatrist's office agreement forms apply to telehealth services. This document is an addendum to, and does not substitute for, our standard in-office services agreements.

The advantage of telehealth is that it can flexibly provide continuity of care when an in-person treatment session cannot be conducted in the office. Similar to a regular in-person therapy session, telehealth by videoconference allows for both verbal and non-verbal communication. Telehealth is not a universal substitute, nor the same as, in-person psychiatric service. Some people say that telehealth services do not have the same level of comfort and may not seem as complete when talking about personal and private matters. Misunderstandings can more easily occur. This may impact the professional therapeutic relationship. Just as with in-person psychotherapy, telehealth services are never guaranteed.

Telehealth may work best when face-to-face sessions have formed the beginning of our relationship. Telehealth requires reasonable comfort with technology. Telehealth is best for augmenting in-person services when the client is unable to come in to the physical office location due to temporary limitations, such as medical conditions limiting physical mobility, distance due to travel, and scheduling conflicts. Ideally, it is recommended that we meet in-person in the office in order to provide optimal care. In extreme circumstances where services reasonably should not be provided remotely, Dr. Pedraza may recommend coming in to the office, waiting until you can come into the office, or referring you to a psychiatrist/psychotherapist or clinic who can provide such services locally. Professional services are being provided under a license issued by and limited to practice within the state of New York and New Jersey. Therefore, the client affirms that s/he resides in the state of New York and/ or New Jersey at the time of telehealth services.

Telehealth is not recommended for a psychiatric emergency. If your psychiatrist believes you would be better served by face-to-face service, and your therapist are unable to accomplish that together, you will be referred to professionals in your area who can provide such services. Just as with in-person services, if an emergency should occur during a telehealth session, Dr. Pedraza may consider taking any steps necessary to ensure the safety of the client or of others.

Just as with an in-person appointment, telehealth sessions are scheduled by prior arrangement. Scheduling a telehealth appointment involves reserving time specifically for you. Just as with in-person appointments, you are responsible for keeping all telehealth appointments. The 24-hour cancellation policy still applies to these scheduled sessions. We should usually start and end on time. In all telehealth sessions, the provider will initiate the telehealth session, unless other arrangements have been made. A window will remain open around the starting time of your appointment. Just as with an in- person session, if Dr. Pedraza doesn't hear from you, he will attempt to reach you but will discontinue after two attempts. Cancellations and unkept appointments are treated just like in-person cancellations and unkept appointments. Dr. Pedraza is not responsible for the client’s ability to participate in the session, including technological limitations.

The laws that protect the confidentiality of your medical information in the office also apply to telehealth sessions, including mandatory and permissive exceptions to confidentiality. The client and psychiatrist both agree to keep the same privacy safeguards as during an in-person session. The environment should be free from unexpected or unauthorized intrusions or disruptions to our communication. There is a risk of being overheard by a third party near you if you do not conduct the session in an enclosed private room, with reasonable sound barriers, and with no one else present or observing. The client and provider both agree to not record the telehealth sessions without prior written consent of both parties.

You have the right to opt in or opt out of the methods of telehealth communication at any time, without affecting your right to future care or treatment. It is your responsibility to discuss prior to the telehealth session which medium will be used, how to use it, and any necessary preparation.

No electronic transmission system is considered completely safe from intrusion. Interception of communication by third parties remains technically possible. Due to the complexities of electronic media and the internet, risks of telehealth include the potential for release of private information, including audio and images. So, your psychotherapist cannot fully guarantee the security of telehealth sessions. You are responsible for information security on your computer, laptop, tablet, or smartphone. As a policy, I ask for your agreement to NOT record telehealth sessions. While a variety of software programs are available for video conferencing, such as Skype, Facetime, or GoToMeeting, not all are encrypted, or compliant with Federal law to protect the privacy of your health communication. I use software with encryption to maximize your confidentiality.

Telehealth can include telephone sessions. When using the telephone, remember to be in a place you feel comfortable speaking about personal and private matters. If you are using a cellular telephone, remember that not all calls or telephones are absolutely secure and may be compromised by various detection devices. A landline is preferable because it is more secure, more reliable, and often offers clearer audio quality.

The client is responsible for his/her own hardware and software, audio and video peripherals, and connectivity and bandwidth considerations. At the time of the telehealth appointment, it is your responsibility to have your electronic device on, video conferencing software launched, and be ready to start the session at the time of the scheduled telehealth appointment. Before an initial telehealth session, a test call up to 10 minutes in advance can be arranged to ensure that technology is functioning properly. If a video telehealth session is blocked after several reasonable attempts, be open to having a telephone session for that time.

Just like in-person services, telehealth services are a professional service, and a fee is charged at the same rate as in-person services. Even when health insurance covers in-person services, health insurance may limit or deny coverage of telehealth services. You are responsible to confirm and know in advance what your insurance may or may not cover. If your insurance does not cover telehealth services, you will personally be responsible for full payment.

I have read and understand the information provided above. I have discussed any questions with Dr. Juan Pedraza MD. All of my questions have been answered to my satisfaction. I hereby request and consent to telehealth services as a part of my treatment. I agree to abide by the terms of this agreement.

Below are specific technical instructions for preparing for your initial telehealth session. Please read this carefully. If you have any questions, please contact your psychiatrist in advance of your first telehealth appointment.

You are responsible to provide your own hardware and software, audio and video peripherals, and internet connection.

In my office, I use Zoom videoconferencing software and Theranest EMR teleheath services. Zoom meeting software can be downloaded from Zoom.us and is free, allows secure communication via real- time audio/video. So, it is fully compliant with federal telecommunication security protocols. Zoom runs on any operating system, and any hardware including desktop computer, laptop, tablet, or cellular telephone. Theranest is also fully compliant with federal telecommunication security protocols. You will receive a link to open the session.

Telehealth videoconferencing can take increased set-up time and requires reasonable comfort with technology. Please test all of your systems and technical capabilities ahead of time. Before your first session with the provider, we recommend that you ensure that your software and hardware are working together properly and that you know how to operate them. Confirm your internet connection and wireless router are fast enough to provide a full signal and won’t be saturated. We recommend you shut down all unnecessary other programs and apps before installation. Go to zoom.us and download the free software. Although Zoom is very simple, learn the basic menus, try all the features, test your settings. Click on “Settings,” then “Audio and Camera Setup.” Make sure that your camera and microphone are working.

Before an initial telehealth session, a test call can be arranged with your therapist to ensure that technology is functioning.

Make sure your video conference session is in a private place, free from distraction or intrusion. A room with a door that closes is best. Confirm there is plenty of even light with minimal glare. Aim your camera. Check your camera angle. Check to see that your face can be seen. Avoid positioning your camera too low or too high. Try to fill the screen as much as possible. To maximize audio quality, freedom from extraneous noise, and privacy, a headset or earbuds may be better than a speaker and microphone. The most important part of a video conference is not the video––it is the audio. Speak in your normal voice, without shouting. Avoid "double talk." Double talk is when both people talk at the same time. Double talk may cause audio feedback and echo. Allow the other person to finish speaking before you speak. Since audio has a very slight delay, you may want to pause briefly for the therapist to respond or to make comments.

Please dress as you would for an in-person appointment.

Just as with an in-person appointment, schedule your telehealth session in advance. 10-15 minutes before the appointment time, have your device on, video conferencing software launched, and be ready to start the session at the time of the scheduled telehealth appointment. We recommend you shut down all unnecessary other programs before the session. Your therapist will initiate the call at the appointment time.

If the connection is distorted or interrupted by a technical malfunction, we may reconnect and try again. If a video telehealth session is blocked after several reasonable attempts, please be open to having a telephone session for that time.