MARCH-PSS
Medical Action for Relief Counseling and Healing for Christ- Psychosocial Support Services
pfaotvolunteers@gmail.com
VIRTUAL COUNSELING SESSIONS INFORMED CONSENT FORM
I, ________________________________________ am choosing to facilitate my counseling via the internet through Google Meet (meet.google.com) and Zoom (zoom.us) and phone calls with MARCH-PSS. By choosing any of these options, I understand that:
- Google Meet and Zoom and are online communication tools allowing for face-to-face video, video, voice, or text-based chat dialogue. Both are encrypted using the Health Insurance Portability and Accountability Act of 1996 (HIPAA) required by the US government to protect sensitive information.
- Zoom and Google Meet applications must be downloaded into your mobile phones, laptop or computer and an account setup. However, Google Meet can also be accessed through a web browser when using a laptop/computer.
- For best video and audio quality during virtual meetings, a stable internet connection is required as much as possible. Headphones and/or earphones add additional security.
- An online appointment request form for profiling and scheduling is used by the organization for decking and tracking clients. This hyperlink is found on the Facebook page of this organization: MARCH -PSS Cebu.
- For phone calls, the client will input his/her contact number in the profiling form. The organization will contact the client to inform him/her of the counselor’s contact number and could make confirmations and clarifications prior to his/her counseling schedule.
- For online counseling, the counselor will send an email with the hyperlink of the virtual meeting five minutes prior to the session. The client is encouraged to join the meeting alone, in a quiet room and door closed for them to be prepared as soon as the email is sent.
- For phone call counseling, the client should send a text message five minutes prior to the session to inform and confirm his/her attendance for the scheduled time. If no confirmation is received within five minutes, the counselor will call the client.
- It is the client’s discretion to opt for Facebook Messenger when other platforms are not accessible.
I also understand the following limitations of these virtual counseling sessions:
- Facebook Messenger is not 100% guaranteed to be secure/confidential since this online platform is not HIPAA compliant.
- Once a client avails the psychosocial support service, audio recording and taking of photos and videos during counseling is not allowed and prohibited by the non-disclosure agreement of the organization.
- In case, client needs further assistance and referrals to more specific services and programs for such concerns, client will be referred to Wellbeing Cluster PH- Cebu Chapter, wherein an intake referral form has to be filled-up prior. Afterwards, they will connect with their professional service providers for the specialized care needed.
- Confidentiality should be treated like an in office session: no outside distractions, no unnecessary noises, turn off mobile phones (for those using the online counseling), close other programs on the computer and be on time.
- Technical problems could occur. If the call is disrupted, the counselor will call back within 10 minutes. If reconnection cannot occur, the session will be rescheduled through email and/or text message.
- The online sessions cannot take place during regular working hours, however in the event that the client cannot spare extra time outside his/her working hours, then the sessions may occur within the client’s most convenient time and can include within his/her working hours provided that the counselor and client have mutually agreed.
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